ROTARY PURSUET PERFORMAKCE EN
REACTNE AND PROCESS SCHIZGPHRENECS

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ROTARY PURSUIT PERFORMANCE IN

REACTIVE AND PROCESS SCHIZOPHRENICS
presented by

Walter Otis Smith

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ROTARY PURSUIT PERFORMANCE IN
REACTIVE AND PROCESS SCHIZOPHRENICS

BY

Walter Otis Smith

AN ABSTRACT

Submitted to the School for Advanced Graduate Studies of
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

DOCTOR OF PHILOSOPHY
Department of Psychology

1959

Approved %' K? M)

Date /; ’/// .51?

 

Walter.O. Smith

ABSTRACT

The present study was concerned with obtaining an ob-
Jective description of the adaptive responses of process and
reactive schizophrenics in a motor learning situation. Per-
formance on a pursuit rotor task was chosen as a convenient
method of accomplishing this purpose.

A process schizophrenic is best described as having an
early and insidious onset of psychosis with a relative absence
of precipitating stress. Typically, he has had an inadequate
prepsychotic personality. He shows a tendency to avoid inter-
,personal contacts and presents a clinical picture of flat ‘
affect and a relative absence of confusion.

A reactive schizophrenic, on the other hand, is one with
as relatively abrupt and stormy onset of psychosis, usually
eattributable to a logical and significant stress situation.
Inie prepsychotic personality has been normal or neurotic,
zuather than schizoid, with perhaps some degree of outgoingness.
Tune clinical picture following the psychotic break is likely
t4) include severe confusion and many affective components.

In the present investigation, Becker's modification of
1319 Elgin Prognostic Scale was utilized for selection of
‘PINDcess and reactive schizophrenics from the schizophrenic
POpulation of a Veterans Administration neuropsychiatric
hospital. All schizophrenic patients who had been diagnosed
3*! psychotic for less than one year were rated on Becker's
Bcéile, and these ratings were found to approximate a normal
OUJPve. Subjects in the upper and lower tails of the dis-

trdfbution were classified as process and reactive respectively.

Walter O. Smith

Each of the psychotic classes so selected was divided
into four groups with 10 subjects in each group. Pairs of
groups (10 subjects from each psychotic class) were then
assigned to four conditions of spacing and massing of practice
‘while learning the rotary pursuit task. Massed practice (M)
was defined as continuous practice throughout a practice
period, and distributed practice (D) was defined as alternat-
ing 30 seconds practice and 30 seconds rest. The four con-
<iitions of practice were M-M-M, M—D-M, D-D-M, and D-MEM. The
first practice period consisted of six minutes of practice
:for all subjects, the second of nine minutes, and the third
<3f three. The third and final period was massed for all
tsubjects. Two five-minute rest periods separated the three
Jaractice periods.

Comparisons between process and reactive patients were
Inade on the bases of time on target, temporary inhibition,
teonditioned inhibition, warmdup decrement, and time taken to
regain set after a rest.

It was found that no significant differences existed
zamong the eight groups at the beginning of practice in the
first practice period nor during the entire final period
(Turing which all subjects practiced under massed conditions.
fEhus it is strongly indicated that differences in psychomotor
fibility or in learning were not the effective factors in
bringing about differences in performance.

During the other phases of testing, differences which

’Eflaowed a high degree of consistency with each other were

Walter O. Smith

obtained. Statistical treatment of the data provided con-
siderable assurance that these differences did not arise by
chance.

The chief findings with respect to process schizophrenics
were: They took longer to adapt themselves and enter into
the task. After a rest, they also took longer to regain their
set and warm up in resuming practice. When continued under
the same conditions for successive practice periods, they
progressively improved in performance. When shifted from
spaced conditions to the relatively more demanding massed
conditions, however, their performance was disrupted.

These results were interpreted as indicating that process
schizophrenics were hesitant in initiating new activities and
Prone to withdraw when thwarted. In other words, they avoided
a. threatening external situation by withdrawing from activity.
Supportive evidence for this interpretation is found in
Studies of "chronic" schizophrenia and in the few reported
Studies that have made use of the process-reactive concept.

Findings regarding reactive schizophrenics were largely
in the opposite direction. They entered into the novel situ-
ation more quickly and took a shorter time to regain set after
a rest. When continued for successive periods under the rel-
atively undemanding spaced conditions of practice, their per-
1‘ ormanoe deteriorated. 0n the other hand, performance con-
tinued to improve with successive periods of massed practice.
when conditions of spacing and massing were shifted in either

direction, these patients showed relative improvement in

Walter C. Smith

performance .

These results were interpreted as evidence that reactive
schizophrenics avoided their internal environments by a
flight into activity. Then, when increasing skill rendered
the easier task less effective as an escape device, satiation
set in quickly. Any change in the task, even to more noxious
conditions, was therefore reacted to positively.

Some supportive evidence for this interpretation is
found in the literature on "acute" or "early" schizophrenia
as well as in studies of process and reactive schizophrenia.

In summary, it was concluded that process and reactive
schizophrenics demonstrated some real differences in their
responses to the rotary pursuit task, and that these per-
formance differences could best be explained as arising from
differing habitual modes of adjusting. These results are
viewed as possibly having important implications for prog-

nosis and therapy of schizophrenic patients.

ROTARY PURSUIT PERFORMANCE IN
REACTIVE AND PROCESS SCHIZOPHRENICS

BY
Walter Otis Smith

A THESIS

Shibmitted to the School for Advanced Graduate Studies of
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1959

50*

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INF

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TABLE OF CONTENTS

INTRODUCTION
Schizophrenia
Development of the Process-Reactive Concept
Adaptation
Motor Learning

Warm-up

Reminiscence
Adaptation in Schizophrenia
Development of the Problem
PRELIMINARI STUDY

Apparatus

Procedure

Results and Discussion
MAIN STUDY
Purposes of the Investigation
Methodology

Apparatus

Subjects
RESULTS
DISCUSSION

Limitations of Conclusions

Implications
SUMMARY
BIBLIOGRAPHY
APPENDIX

Effie?

76
86
88
94
97
106

Table

Table

Table

Table

Table

Table

Table

Talile

Table

Tabl e

Tabl e

TatiLQB

Tabl e

TaquE,

10

11

12

13

14

LIST OF TABLES

White's Rank Test Applied to Estimated Degree
of Psychosis in Process and Reactive Patients

Analysis of variance of Total Time on Target,
Last Half of Practice Period 1

Tukey's Gap Test Applied to Differences in
Time on Target, Last Half of Practice
Period 1

Analysis of Variance of Total Time on Target,
Last Half of Practice Period 2

3 Test of Differences in Time on Target
Between Groups RDM and RMM, Last Half of
Practice Period 2

Test of Differences in Mean Time on Target
etween Groups PDM.and PMM, Last Half of
Practice Period 2

3 Test of Differences in Gains Between Groups
RDD and PDD From First to Last Minute of
Practice Period 2

Analysis of variance of Time on Target
During Practice Period 2

Analysis of variance of Reminiscence Over
First Rest Period

Analysis of variance of Reminiscence Over
Second Rest Period

Analysis of Variance for Amount of Warm-up
Decrement at the Beginning of Practice
Period 2

Analysis of variance of Warmrup Decrement
at Beginning of Practice Period 3

Time to Warm Up, Beginning of Second Practice
Period, Z-Scores for Differences Between
Groups

Analysis of variance of Temporary Inhibition
Dissipated Over the First Rest Period

Page

54

58

62

63

6A

64

65

67

67

68

69

69

72

Table 15

Table 16

Table 17

Fig.
F15.
F345.

F343.

«toms-o:

Analysis of variance of Temporary Inhibition
Dissipated Over Second Rest Period

3 Test for Conditioned Inhibition Following
First Practice Period

3 Test for Conditioned Inhibition Following
Second Practice Period

LIST OF FIGURES

Performance Curves and variables,
Preliminary Study

Ratings on Elgin Prognostic Scale Assigned
To Population From Which Psychotic Samples
Were Drawn

Normal Group, Mean Time on Target

Normal group, Percent Time on Target
Reactive Groups, Mean Time on Target

Process Groups, Mean Time on Target

Mean Times on Target, First Practice Period

73

74

75

4O

47
55
56
59
59
6O

AC KN OWLEDGEMEN TS

It is indeed a pleasure for the author to acknowledge
his debt to the members of his committee: Dr. M. Ray Denny,
who served as chairman, Dr. Paul Bakan, Dr. Donald L.
Grummon, and Dr. Donald M. Johnson. Their suggestions are
incorporated in every phase of this thesis. The constant
guidance, encouragement, and interest of Dr. Denny were
especially vital from the original design of the experiment
to carrying it through to completion.

The author also wishes to thank Dr. Stewart G. Armitage
and his staff at the Fort Custer Veterans Administration
Hospital for making available the time, facilities and

subjects necessary for carrying out this study.

INTRODUCTION

Schizophrenig

Every student of psychopathology knows or soon learns
that we are indebted to Emil Kraeplin for his grouping into
one psychological entity the varied forms of what is today
(at least in the United States) called schizophrenia. The
name which Kraeplin applied in 1896, dementia praecox, was
borrowed from the French psychiatrist Morel. Kraeplin, how-
ever, used the term in a different sense than did Morel and
is thus to be credited with the concept in its present
meaning (15). Under the classification of dementia praecox,
Kraeplin subsumed mental disorders which had been known and
described previously but which had been regarded as separate
clinical entities. He still, however, divided the patients
into three sub-groups: the hebephrenic, the catatonic, and
the paranoid. Later, he accepted as belonging in the same
category a fourth type (the simple) which was suggested by
Bleuler (24). Among these apparently dissimilar cases,
Kraeplin was able to discern common characteristics, the most
Outstanding and most important of which was a progressive
tendency toward a state of dementia. Using this as the
Primary criterion, he found he could differentiate from other
illnesses and define as dementia praecox a syndrome also in-
cluding incongrous affectivity, negativism, impairment of
aittention, stereotyped behavior, hallucinations, and delus-
ions in the presence of a relatively well preserved

1

orientation in time, space, and personal identity. He also
separated from the dementia praecox group a new nosological
entity which he called "paraphrenia". Here, as in dementia
praecox, the outcome of the disease was the fundamental con-
sideration since a patient with paraphrenia suffered no de-
cay of the personality. As to etiology, Kraeplin thought of
dementia praecox as an endogenous illness. At first he
thought it was due to some organic pathology of the brain.
Later, he stated that it might be due to a metabolic disorder.
It becomes apparent, then, that almost from the time he
introduced the concept of dementia praecox, Kraeplin himself
began to be concerned about the questions that have plagued
theorists and investigators ever since. The great merit of
identifying relationships and consistencies among the diverse
symptomatologies is self-evident. On the other hand, the
very process of grouping involves a danger of ignoring or
concealing differences by putting all cases under one blan-
ket as it were. First, as Kraeplin himself came to recog-
nize, not all cases of dementia praecox meet even the origi-
nal criterion of ending in dementia. Some cases stabilize
at a less severe level, and some even seem to make complete
recoveries. In the second place, not all cases begin early
in life, and, third, not all cases that deteriorate pro-
Sressively do so precipitously (21, 21+, 26, 43, 44, 53, 111,
113, 118). Thus it became increasingly evident that the
term dementia praecox could not appropriately be applied to

2

the illness, and that some fundamental changes in the con-
cept were needed. Additional difficulties arose from
Kraeplin's method of attack. The finalistic method of making
or changing a diagnosis on the basis of the outcome of the
dj. sease is not compatible with a scientific search for the
causes rather than the effects. Associated with this was
Kraeplin's confining himself to a purely descriptive ap-
proach, always cross-sectional in nature even though the
concept itself entailed a process rather than a specific
state.

For these, and perhaps other reasons, Kraeplin's contri-
butions met with considerable opposition. Eugene Bleuler
(24), however, accepted many of the Kraeplinian concepts, and
he revised and revitalized them by an attempt to go beyond
the purely descriptive level. He advocated the term
nschizophrenia", implying that a splitting of the various

Psychic functions was outstanding among the symptoms which
he saw as fundamental to the disease and so present to some
BXtent in every case of it. He also saw a particular type
or thought and behavior which he called "autism" as basic
to the disease of schizophrenia. He recognized that the out-
Come was not invariably poor, noting that almost complete
remi ssion was possible in some instances, especially where
a relatively late and sudden onset occurred. Adolph Meyer
(91 ) also advocated replacing the term dementia praecox
W111h schizophrenia. In addition, Meyer suggested a

3

psychobiological approach to mental disease which could en-
compass the interaction of constitutional factors with
environmental ones in determining the course and outcome of
the disease in question. Sullivan (114) believed that
“schizophrenia" should be applied to only those "disorders
of living" which have an acute onset due to some identifiable
stress situation and a good prognosis, while "dementia
praecox" should be reserved for that disorder having an in-
sidious onset and a poor prognosis and which seems to be an
organic, degenerative disease. Strecker and Wiley (111)
arrived independently at essentially the same conclusions.
Development 9; the Process-Reactive Concept
Perhaps taking a leaf from Kraeplin's book, investi-

gators of schizophrenia have used outcome of the illness as
a popular criterion for classifying patients. It has been
repeatedly observed that some patients have relatively
severe and "stormy" schizophrenic breaks while in others the
i1 sease develops in an insidious manner over a period of
years beginning in early childhood. Along with this, it has
be 811 noted that a startling positive correlation exists be-
tween 8. late, sudden and stormy onset on one hand and good
Prognosis on the other. Conversely, the patient who under-
8098 a progressive and gradual deterioration is much less
likely to recover (24, 66, 79, 86, 111, 121, 122). Langfeldt
(79) introduced the term "process schizophrenia“ to describe

the poor prognosis group while he labeled the group With

4

better prognosis "schizophreniform". D.E. Cameron turned
his attention to the early symptoms and distinguished two
main groups on the basis of their activity levels (29). His
evidence indicates that hypoactive patients usually show
these characteristics for a longer time before hospitalization
than the hyperactive patients have shown behavioral abnormal-
ities. Low activity—level, then, is most often associated
with insidious onset. The patient's personality prior to
his becoming psychotic was focused upon by Darrah (33). He
considered dementia praecox to be characterized not only by
early and insidious onset with progressive deterioration,
but also by a schizoid prepsychotic personality. 0n the
other hand, schizophrenia was shown by an abrupt onset and a
milder, nondeteriorating course of the disease, and was
usually associated with an adequate prepsychotic personality.
These views have generally been confirmed by other investi-
gators (66, 86, 111, 124). Other ways which have effectively
divided the patients into two groups correlating with their
Prognosis found: 1) Inappropriate or dull emotionality implies
POOI‘ prognosis while neurotic and affective features are in-
dlegitive of good prognosis (33, 79, 86, 111); 2) Identifiable
Precipitating stress is associated with good prognosis, and
its absence is an ominous sign (33. 66, 86, 111, 114); 3) A
“clouded sensorium" is a more favorable sign than retention
of orientation in time, place and personal identity during a

Psychotic episode (24, 66, 67, 111, 122); and 4) a family

history of schizophrenia is associated with a poorer chance
for recovery (33).

In contrast to the dichotomous or bimodal distribution
of schizophrenic patients suggested by the above discussion,
Wittman and Steinberg (121) concluded, after studying case
histories of neuropsychiatric patients of all types, that a
bell-shaped curve seemed more descriptive of the actual pop-
ulation. Their distribution ranged from “process" at one
end of the scale to "manic-depressive" at the other with
categories of "schizophrenic", "normal", and “hypomanic and
depressive" falling in that order between the extremes. The
writers also concluded that their study provided supportive
evidence for Meyer's theory of the "shut-in" personality type,
a concept very similar to Langfeldt's "process schizophrenia".
The continuum idea, suggested by Wittman and Steinberg as
descriptive of the population at large, was applied to
schizophrenic patients by Bellak (21, 22). After reviewing
3200 papers, manuscripts, and books on schizophrenia, he
formulated what he called a "multiple factor theory" of its
etiology. Each case, he suggested must be seen as the result
of both somatic and psychogenic features and ..."it may be
helpful to conceive of any given case as actually occurring
on some point of a continuum from a hypothetical point of
almost complete psychogenicity to a hypothetical point of
almost complete organicity" (22, p 740). The common denom-

inator in all cases, according to Bellak, "is a severe

6

decrease of ego strength to a point where the ego is incapa-
ble of mediating properly between Id, Superego, and reality"
(22, p 752). Consequently, there is a return to more primi-
tive patterns of behavior. Ausubel (l6, l7) concurred with
Bellak in describing schizophrenic patients in terms of ego
deficiencies, but concluded that two distinct forms, "evo-
lutionary" and "reactive" could be clinically recognized.

Kantor, Wallner and Winder (67) were the first to label
as such the "process-reactive" dichotomy. Strong indications
of reactive schizophrenia were felt by these authors to be:
(1) a relatively normal pre-psychotic personality; (2) sudden
onset with the presence of logical precipitating factors and
(3) loss of a clear sensorium. The process syndrome showed
Just the opposite characteristics. After their subjects were
rated as either "process" or "reactive" from case history
data, they were given the Rorschach test and designated
either "psychotic" or "non-psychotic" on the basis of their
Rorschach responses. It was found that reactives tended to
be called non-psychotic and that the process group tended to
have a greater number of psychotic-like responses. The
authors concluded that there is a legitimate basis for classi-
fying schizophrenics as either process or reactive and that
the two groups differ in their "psychological function
characteristics".

Brackbill and Pine (27) also administered the Rorschach

test to patients classified as being either process or

7

reactive and to a third group with "known central nervous
system pathology". They found that the reactive group was
distinguishable from the other two but that the process
schizophrenics could not be differentiated from the organics
on the basis of Rorschach signs. These results suggested to
the authors that the difficulty in arriving at a differential
diagnosis between "some kinds of schizophrenia and organics
results from the involvement of central nervous system path—
ology in process schizophrenia". A recent study by McDonough
(84) tested this conclusion by use of two perceptual tasks
on which individuals with cortical damage have shown gross
defects. His schizophrenic patients were screened to include
only those with no known brain injuries or brain tumors.
Then they were classified as being either process or reactive
on Becker's revision of the Elgin Prognostic Scale (see
appendix) and compared with a group of normals and with a
group of individuals having known brain damage. The tests
used were for critical flicker fusion and for the Archimedes
spiral aftereffect. On the basis of test results, normals
and both groups of schizophrenics could be distinguished
from organics but not from each other. No evidence of corti-
cal damage in schizophrenia could be adduced from these data.
In two recent publications Becker (19, 20) advocates
the continuum position proposed by Bellak. He cites Bellak's
evidence for multiple causation of schizophrenia and also

points out that in clinical practice the two groups are

8

found to merge into each other and to overlap. Rather than
making distinctions in terms of etiology, as Bellak did,
Becker prefers to speak of a continuum of "levels of person-
ality organization" with the process group at a level of
"very primitive undifferentiated personality structure, and
the reactive syndrome a more highly organized one". Although
there is no necessary contradiction between this view and
Bellak's, Becker believes that the patients level of function-
ing affords a more fruitful point of departure. He conducted
a study in which schizophrenic patients were classified by
means of a prognostic scale as being on a process-reactive
continuum. Then each subject was given a Rorschach and a
proverbs test with the expectation that process schizophrenics
would show more regressive and immature thinking than would
be shown by the reactives. This hypothesis was confirmed to
a large extent. Statistically significant relationships
between position on the continuum and Rorschach "genetic"
Scores were shown by both male and female patients. On the
Proverbs test, however, only the male patients showed the
predicted differences to a significant degree.

Evidence from a number of studies, then, indicates that
dividing schizophrenic patients into two groups, process and
I‘ea'octive, affords an additional dimension which is useful in
describing the individual patient. The hypothetical "pure"
proCess schizophrenic has grown gradually into his psychosis

<3“’«I‘ing the course of his development; diverging from the

9

path of "normal" development at an early age and progressively
increasing his distance from the normal path as he matures.
The hypothetical "pure" reactive, on the other hand, is an
individual who has made a relatively satisfactory adjustment

prior to "suddenly" becoming psychotic when subjected to ex-
treme stress. While these "pure" forms are rarely, if ever,
identifiable in actual practice, it has proven to be possible
to distinguish between the primarily process and the primar-
ily reactive schizophrenics with a high degree of reliability.
Once such a distinction is made, significant differences be-
tween the groups in terms of prognosis and in terms of differ-
ing behavior in a variety of experimental situations can be
found. It therefore seems possible, or even probable, that
some aspects of schizophrenia are obscured by the use of
traditional Kraeplinian diagnostic labels. There is also
reason for hope that use of the process-reactive system of
classification and description may afford opportunities for
additional insights into the nature of schizophrenia. The
Possibilities appeared promising enough to the writer to
Justify incorporation of the concepts in the present
1nVe stigation.
adaptation

Adaptation is a biological necessity. Every surviving
8Peeies has, during the course of its evolution, developed
adaptive and protective mechanisms which facilitate adjust-

ment to the conditions it must meet. These mechanisms 0f

10

adjustment, often operating without conscious volition or
even awareness on the part of the individual, enable him to
deal more efficiently with inner situations or environmental
conditions that might otherwise disrupt his functioning.

Within the field of clinical psychology, experimental
investigators and theorists have, traditionally, focused
their attention almost entirely upon the "defense mechanisms”
having to do with ideation. Examples of these are repression,
resistance, suplimation, rationalization, reaction-formation,
and Erojection. Noyes, in his recent book (92) describes and
discusses no less than twenty'defense mechanisms of this
nature. Since these particular modes of adjusting are not
the primary concern of the present investigation, the in-
terested reader is referred to any standard text of person-
ality dynamics for a more thorough discussion (57, 92, 118).

More recently, attention has been given to differences
in Physiological responsiveness as indices of comparative
effectiveness in adjusting. Extensive work in this area has
been carried out by Selye (103) and his CO'WOI'RGPS- They
Offer evidence of a triphasic pattern in the evolution of
adaptation to any affront to the organism. The affront may
be Of any sort including such diverse conditions as physical
mJUry, changes in temperature, fear, psychological stress,
or infection. Under all these conditions, the physiOlogical
r eac‘bivity follows the same “general adaptation syndrome“

(GAS). The beginning phase or "alarm reaction" is

11

characterized by generalized and increasingly diffuse adaptive
responses necessitated since no organ system is as yet spec-
ifically developed to cope with the task at hand. Following
this is the "stage of resistance" in which the appropriate
organ system has mobilized to handle the stress. It alone

is activated by the regular or continuing stress, and other
physical reactions of the body proceed more or less normally.
Finally, if uninterrupted, the process leads to the “stage

of exhaustion" in which diffuse and uncontrolled reactions
appear once again due to the inability of the organism to
maintain its confinement of the stress to a limited area, and
this stage continues until death. Each stage is character-
ized by measurable changes in the physical organism. Selye
posits a certain amount of ”adaptation energy" present at
birth, and most probably genetically inherited, which the
individual may spend lavishly or frugally, but which cannot
be replaced. According to this view, physiological reactiv-
ity is determined by the severity of stress, the length of
time since inception of stress, and the individual's reserves
of "adaptation energy" rather than being a function of the
particular disease or agent which acts as stressor.

In a study specifically investigating differences in
adrenal cortical responses associated with personality dis-
orders, Pincus and Hoagland (96) found that schizophrenics
as a group showed adrenal cortices typically less responsive

to stress and unable to alter action to meet changing

12

 

alfiujlfi ‘

environmental demands. Funkenstein and his co-workers (46,
47, 48) conducted a series of studies investigating possible
relationShips between physiological reactivity to drugs and
remission of illness in schizophrenia. They found that
patients diagnosed as being schizophrenic were quite varied
in the degree of their autonomic nervous system responses
when given epinephrine and mecholyl. Seven subgroups were
formed on the bases of blood pressure and re-establishment
of homeostasis. It was found that patients who showed the
greatest reaction to the above drugs had the best recovery
rates following electroshock therapy. Funkenstein gt a;
concluded that their measurements of autonomic reactions pro-
vided a better prognostic indicator than did the clinical
diagnoses of the patients. These conclusions were confirmed
in later studies by Hirschstein (52) and by Geocaris and
Kociker (49).

Williams (119) investigated the autonomic reactivity of
schizophrenics in response to psychological, rather than
chemical stressore. He defined his eXperimental group more
carefully and confined his study to "early chronic schizo-
phrenic reactions". His patients were called "early chronic"
if they had been hospitalized one to three years and had
shown ”little or no lasting response to treatment“. The
diagnosis in each case was agreed upon by three psychiatirsts
and three psychologists. He found that When the galvanic

skin response (GSR), pulse, and respiration rates of these

13

patients were compared to those of normal subjects, some
consistent differences appeared. The schizophrenics showed

a greater than normal background physical activity when they
were at rest, and the higher activity level tended to con-
tinue under stress conditions with a less-than-normal amount
of variation under changing conditions. These findings were
confirmed and extended by Devault (36) who took even more
variables into account as he sought to relate the findings

of Funkenstein gt_a; to the process-reactive concept of
schizophrenia. Devault selected schizophrenic patients wh
could be classified as either process or reactive from in-
formation concerning their pre-psychotic personality, appar-
ent precipitating stress, type of onset, and clinical picture.
Then he compared the autonomic reactions to psychological
stress of these two groups with each other and with the re-
actions of a control group of normal subjects. Each subject
was shown four pictures, one ”neutral" and the others chosen
to express feelings of “hostility", "dependency", and "sex".
In addition to these stimuli, a loud bell was sounded follow-
ing a verbal warning that it was to be rung. Measurements

of the subject's base level and amplitude of heart rate,

base level and amplitude of GSR and length of time for GSR
arousal and recovery were taken. His reactive schizophrenics
were similar to normal subjects in amplitude of GSR and
changes in heart rate, but tended to be slower in homeostatic

recovery than either the normal or process group. His

14

process group resembled Williams' "early chronic" schizo-
phrenics in showing less extreme and slower changes in GSR
and heart rate than the other two groups.
£939; Learning

(A related but separate approach to studying an indiv-
idual’s adaptive functioning is offered by analysis of his
learning processes. Since learning is perhaps the most
characteristic form of human adaptation, its importance is
obvious. It is hardly surprising, then, that a very large
proportion of psychological literature is concerned with this
general area. More specifically, the area of motor learning
provides opportunities for obtaining objective measurements
of several variables in the learning process, and it has
increasingly occupied the attention of psychologists since
the beginning of the present century. Laboratory studies
have usually been directed at finding a relatively simple
type of motor activity with which the learner has had little
or no opportunity for previous experience. Then systematic
observations and analysis of changes in performance are made.
Pioneer studies of qualitative changes at various stages of
learning of skills are reviewed by woodworth (125) and by
McGeoch (85). There is a striking regularity in the various
reported curves of motor learning. From a mass of experi-
mental investigations, the following consistencies in the
learning process have been noted: (1) The majority of studies

of motor learning have shown spaced practice (i.e. practice

15

periods interspersed with rest periods) to be more efficient
than massed practice (continuous performance); (2) During
rest periods between practice sessions, there is a gain in
ability to perform. This phenomenon is usually referred to
as "reminiscence". (3) During the early part of each practice
session after the first, there occurs an increase in per-
formance scores which is relatively rapid as compared with
initial learning. This spurt in performance is now generally
referred to as ”warm-up". These phenomena provide approaches
to the analysis of individual differences in motor learning
which are in addition to such measures of the gross perfor-
mance as speed of learning and the level achieved. According-
ly, they have been widely investigated and have frequently
been the focus of theoretical formulations. It may be noted
that all three of these phenomena involve interruptions of
practice to at least some extent. It is not surprising,
then, that in their attempts to interpret curves of motor
performance, various theorists have concerned themselves with
factors operating in the rest periods either wholly or in
part. A more detailed examination of the pertinent variables
follows.
Essa-L12

In the interference theory of forgetting this would be
attributed to the action of incidental sources of interfer-
ence. That is, some of the cues in the situation become

associated with responses which conflict with the task. One

16

immediately obvious example of such a competing response is
resting in a situation similar to the one in which the act-
ivity is carried out. Irion (61) points out that competing
responses learned in this incidental fashion should be rela-
tively weak in strength as compared with the purposive re-
sponses of the task. Both he and Ammons (6) suggest that a
more important factor than loss of retention is a loss of
the ”set" to perform the task. No matter what the task may
be, certain postural, receptor, and attitudinal adjustments
are most favorable to performance. The subject must look at
the right place at the right time, impress a certain optimal
pace on his activities, and attend to those particular cues
that are crucial in guiding and adjusting his responses. All
these activities contribute towards a background of self-
stimulation that is more-or-less unique for each task and
that is referred to as the "set" to perform this task. This
set, they point out, is a major part of the total stimulus
situation in which the task responses are learned. During

a rest period, the set is lost, the total stimulus situation
is modified, and the probability of correct responses being
made early in practice after the rest is reduced. Upon re-
sumption of practice, the subject must make again the orienta-
tional responses originally associated with the correct re-
sponses. Until he has done so, his performance will be be-
low that which he is capable of achieving after warming up.

Irion first investigated warm-up from the standpoint of

17

re-establishment of set in a verbal learning situation (63).
His subjects were required to memorize paired nonsense syl-
lables as they appeared on a revolving memory drum. After
24-hours rest they were divided into two groups and retested.
The experimental group, before being tested, were placed in
front of the memory drum and required to name colors as they
appeared. This was intended to re-establish the cues of the
original learning situation. The testing for memory of the
nonsense syllables, which followed immediately, revealed
that the eXperimental group not only surpassed the control
(no warmdup) group, but that they showed no forgetting and
had even improved somewhat in performance. Irion, in an-
other study (62), and Ammons (ll) sought to determine whether
Irion's findings regarding the resumption of set on a memory
drum also applied to motor learning. Both investigators
used the pursuit rotor task in their studies. Irion con-
cluded that the amount of warm-up effect is a function of
both the amount of pre-rest practice and of the length of
the rest interval. In other words, it depends upon a com-
bination of how definite a set had been established and how
much of the set had deteriorated. .Ammons (11) used 8 dif-
ferent conditions of pre-practice warmrup after a rest of

17 minutes. "It was concluded that the present types and
durations of pre-practice activity do not produce significant
changes in subsequent performance level, warm-up decrement,

or temporary work decrement. These results do not support

18

an energy-expenditure explanation of temporary work decre-
ment, or a rehearsal theory of reminiscence. They do seem
to indicate that verbal and motor performance are affected
differently by pre-practice warming-up activities" (1, p 191).
A different approach to the measurement and investigation
of warm-up is provided by the method of having the subjects
resume working at the original task without special prepa-
ration. The "warm-up decrement", or the amount by which in-
itial post-rest performance is below expectation because
of the necessity for warming up is then calculated. Ammons'
(6, 7) approach to the problem was to first construct a per;
formance curve showing the subject's scores at frequent inr
tervals during practice. (A straight line was then fitted
by the method of average decrement to the "relatively decre-
mental portion" of the performance curve which follows im-
mediately after the initial post-rest spurt. The line is
extended backwards through the high point reached in this
spurt and extrapolated on back to a point directly above the
score for the first post-rest trial. The difference between
the actual score and the point arrived at by extrapolation
represents an estimate of warm-up decrement. Two methods
for making these calculations in cases where practice is
sufficiently spaced to result in absolute losses in perfor-
mance level were introduced by Adams (3): (a) decremental
method--the difference between the performance level on the

last pre-rest trial and the first post-rest trial; and (b)

19

initial increase method--the difference between the perfor-
mance level at the peak of the sharp initial rise of the
post-rest performance curve and the level of the first post-

rest trial. Both methods have been found to give essentially

the same results (3. 18, 64). Several studies using these

approachs have provided useful information about the nature 1

of warm-up decrement: (1) It appears at the beginning of

each practice session under both massed and distributed con-

aitions (2, 3, 18, 35) and the length of the intertrial rest I

is not systematically related to the amount of it shown (64). I

Thus we can reject the hypothesis that warm-up decrement is

related to the growth of inhibition (or work decrement).

( 2) The warm-up decrements for distributed practice quickly

achieve a maximum and then display a trend of decreasing

magnitude as practice increases (3, l8). This supports

Ammons (6) hypothesis that practice is regaining Set should

lead. to less warm-up decrement. This is demonstrated esp-

ecially forcefully since it has been shown that a positive

relationship exists between amount of warm-up decrement and

the performer's degree of proficiency (2, 64). (3) Massed

Practice produces no consistent warm-up trends (3, 18). It

can be concluded that complicating factors are present under

massed conditions and that distributed practice represents

the Simpler case for the study of the warm-up phenomenon.
W

In some situations reminiscence, or gain over rest, may

20

be attributable to extra practice in the form of overt or
implicit rehearsal during the rest period. That this is not
a sufficient explanation, however, is established by the
fact that spaced practice proves to be beneficial in many
situations where rehearsal is prevented by such measures as
filling the ”rest" period with controlled activity. It also
seems unlikely that rehearsal is an important factor in motor
learning situations in which verbal cues play little part.

Another obvious possibility is that fatigue or boredom
and its concomitant changes in motivation are responsible
for reminiscence. For example, prolonged practice may re-
sult in fatigue, and a rest interval may bring about a re-
covery from it with a resulting improvement in performance.
Granting that this may be a factor, the evidence is against
it being the sole explanation since reminiscence is some-
times demonstrated with learning sessions so short that they
could hardly cause fatigue. The same reasoning can be ap-
Plied to motivational factors. Subjects who have become
bored with a task may well cease to perform optimally and
then show renewed interest after a rest. 0n the other hand,
the consistent appearance of reminiscence after very brief
practice periods makes it unlikely that sudden onsets of
boredom could be the sole explanation.

Still another partial explanation of reminiscence is
ofiE‘ered by McGeoch (85). It is suggested that differential

r‘53-'t:.es of forgetting may be a contributing factor. he

21

n. A“ 0‘...
\
:I
-

 

 

incidental, distracting associations could be expected to be
forgotten more quickly than the elements of the situation
receiving conscious attention. Forgetting of the "wrong"
responses would then make the desired responses more probable.
While this theory has considerable face validity in verbal
learning tasks such as memorizing word lists, it has little
applicability to motor learning in which verbal cues play
little part.

In some motor activities, barriers to response similar
to the "refactory phase“ in neural functioning appear to be
operative. A tendency to avoid repeating responses at short
intervals and also an increase in serial reaction time with
closely spaced stimuli have been demonstrated in a few situ-
ations (55). An extension of this theory postulates a type
of neural "after-effect" which is called "perseveration" by
its authors, Muller and Pilzecker. Their theory is supported
by Woodworth: .

The size and internal structure of the muscle
fibers improve after exercise, and this nutri-
tive after-effect takes some hours to reach
completion. The same after-effect, occurring
in the nervous system, may "consolidate" the
memory trace of an activity (125, p 216).
This concept is capable of explaining reminiscence, but it
is difficult to test since it has not been operationally de-
fined. It appears, also to rest on meager physiological
evidence (55, 117).
The maturation hypothesis of learning is very closely

related to perseveration theory in that it too postulates

22

some kind of growth process following the stimulation from
learning activity. Although this hypothesis "is rooted in
the writings of Wheeler, and of Wheeler and Perkins" (37),
it was first stated in a form specific enough to allow it to
be experimentally tested by Dore' and Hilgard (38). Accord-
ing to these authors, the hypothesis has two aspects which
they describe as follows:
1. A53 maturation "The capacity of an organism to improve
With practice is a function of its age-level of maturation".
(38, p 246).
2. Stimulation-induced maturation "At any given age-matur-
ation level the optimum rate of stimulation to secure improve-
ment in a given function depends upon the normal rate of
stimulation-induced maturation in that function" (38, p 246).
The first part stating that there is a relationship be-
tween the performer's maturation level and his learning
efficiency seems to be beyond doubt. It has been established
again and again by the authors of the various psychometric
devices in everyday use in schools and clinics. Experimental
evidence that it is also true in motor learning situations
has been presented. Adams and Reynolds (2) found interaction
effects between the initial level of ability and gains in
performance among 960 recruit airmen. Ammons, Alprin and
Ammons (12) also found pursuit rotor performance to be re-
lated to both sex and age of school children. The second

part, much akin to the Perseveration Theory above and to

23

Snoddy's (108) "primary growth", has occasioned pause and
more than one lifted eyebrow. According to this principle,
stimulation-induced maturation is a function of time. Within
certain limits which vary according to the nature of the task,
passage of time since inception of practice is more important
than the actual amount of practice undergone. Dore’ and
Hilgard (38) carried out an experiment to test this inference
by use of the Koerth pursuit rotor. Four groups of subjects
were given 7, 13, 22 and 31 one-minute trials in a total
elapsed time of 43 minutes. When their performance was
measured at the forty-first minute, the last three groups
scored about the same while the first-mentioned group scored
considerably lower. While these findings were consistent
with the maturation hypothesis, the authors also pointed out
that this hypothesis need not be envoked to explain the re-
sults obtained since they could be explained as adequately

in terms of more commonly accepted concepts. A later study
by Dey and Ammons (37) utilized a compensatory pursuit task
at which five groups of subjects received either 45, 30, 23,
13, or 8 one-minute trials with intertrial rests of O, i, l,
2%, and 5 minutes respectively. Their results showed
learning to be more nearly proportional to the amount of
practice than to elapsed time and therefore not consistent
with the maturation hypothesis. A thirty-second rest between
trials led to a better performance than did massed practice,

but increases in the length of interpolated rest up to five

24

unnutes did not result in further improvement. EVidence thus
far suggests, then, that reminiscence does occur during the
rest periods and the maturation hypothesis offers a possible
explanation for some of it. However, the same phenomena can
be explained by use of more conventional concepts. In at
least some areas, the Maturation hypothesis as presently
stated would lead to incorrect predictions.

All the formulations so far discussed might be called
single-factor explanations of reminiscence. As Ammons (6)
points out, any curve with two or more inflections cannot
very adequately be accounted for by the simple operation of
one factor, and the curve of motor learning has at least two
inflections. Hull (56) introduced the dual concepts of re-
active inhibition and conditioned inhibition which are now
rather widely used as intervening variables by investigators
of motor learning. Reactive inhibition is regarded as a
negative drive state. It accumulates during work and de-
presses performance since the making of a response sets up
a tendency not to repeat that response. It is assumed to be
a type of temporary inhibitor of response that dissipates
spontaneously during rest. In this way, it is used to ex-
plain part of the superiority of distributed practice over
massed practice, and the gain in performance during a rest
which follows massed practice. Conditioned inhibition is
defined as a habit of resting for which the drive is reactive
inhibition and the reinforcement is rest. Lake reactive

25

inhibition, it depresses performance but, as a habit, it does
not dissipate spontaneously over short rest periods. There-
fore, reminiscence would be described in Hullian theory as
due to the dissipation of reactive inhibition, and permanent
differences in performance found to exist between massed and
distributed performance as due to the greater amounts of
conditioned inhibition generated under massed practice con-
d1 tions.

The Hullian concepts, being incorporated in a more gen-
eral theory and being more widely known as well as being
stated in such a way as to make them amenable to experimental
check, have been more thoroughly investigated than any other
of the foregoing formulations. Melton (90) and Kimble and
his co-workers (68, 69, 70, 71, 72) in a series of studies
confirmed the presence of, and gave quantitative meaning to
the temporary decrement in performance associated with re-
active inhibition and the more "permanent" decrement assoc-
iated with conditioned inhibition. These findings, in-so-far
as they apply to reactive inhibition, have been borne out in
a number of independent studies. With regard to conditioned
inhibition, however, some reservations have been voiced.
Starkweather and Duncan (110) proclaimed themselves unable
to elicit a statistically significant amount of conditioned
inhibition in a study employing the pursuit rotor. As the
authors themselves note, however, they ignored the warm-up

Phenomenon and thus reduced the differences between their

26

 

 

414...... .11...-111fl
.. a

 

 

groups. A.number of studies (7, 3, 18, 64) indicate that al-
though warm-up is not included in Hull's system, ignoring it
is apt to lead to serious misinterpretations of the data.

No single theoretical formulation thus far examined ap-
pears capable of adequately accounting for all the phenomena
noted without more-or-less major modifications. 0n the other
hand, several useful variables have been identified and ex-
perimentally validated. Ammons (5, 6, 9) has provided us
With the logical next step (or, more accurately, a series of
steps) by choosing promising sets of variables and defining
them in.terms of a motor performance curve; then proceeding
to test and give quantitative meaning to the variables chosen.
Ammons' method of calculating warm-up decrement has already
been described. A.backward extrapolation of a portion of
the post-rest performance curve enabled him to arrive at a
"corrected initial level" of postrest performance; 1.6. an
estimate of what the performance on the first post-rest trial
would have been had there been no warm-up decrement. A method
of calculating temporary work decrement (a concept similar
to Hull's reactive inhibition) makes use of the same correct-
ed initial level. In addition to this point, a line arrived
at in an identical manner is extrapolated forward from the
pre-rest practice session to the first trial of the post-
rest practice. This affords an estimate of what performance
would have been on this trial had there been no interruption

of practice. The difference between these two points

27

provides an estimate of temporary work decrement that is
corrected for warm-up decrement. Finally, the amount by
which the corrected initial level is less than the perfor-
mance level of a group practicing under optimum conditions
of distribution of practice is used as a measurement of page
menent work decrement (a concept similar to Hull's conditioned
inhibition).
Adaptation Tn Schizophrenia

Extensive investigations of the adaptive responses of
schizophrenic patients have been carried out. Kraeplin him-
self introduced a technique of setting patients to work at a
continuous task in order to bring out more clearly the deficit
evident in everyday life (57). He observed that with various
types of tasks, schizophrenics work efficiently for a Short
time, but their performance falls off at an abnormally high
rate as they continue at the same task. This seeming inabili-
ty of schizophrenics to maintain goal-directed activity has
also been emphasized by a number of other investigators (51,
58, 59, 60, 76, 87, 104, 106). It should be noted, however,
that these investigators also found that schizophrenics con-
sistently showed both greater intrasubject variability and a
greater range of abilities between subjects than did the
normals. Several possible explanations of this state of af-
fairs were proposed by Huston gt a; (59): Schizophrenia is
said to entail loss of interest in the environment with con-

sequent lowered motivation for task performance; greater

28

occupation with fantasy and therefore more tendency toward

a "drifting away" of attention; reduction in energy output
which would lower the patient's ability for sustained pro-
duction; and inadequate or inappropriate affective response
with its concomitant decrease in predictability of reactions.
To these explanations might be added psychobiological adapt-
ation which is faulty to varying degrees (91), and last but
not least, the strong possibility that heterogeneous groups
were subsumed under the classification of "schizophrenic
patients". In support of the latter possibility that hetero-
geneous groups were subsumed under the classification of
"schizophrenic patients". In support of the latter possi-
bility, Shakow and Huston (60) concluded that when only
"those patients who cooperated as well as the normal group
were compared with the latter the differences between the
groups disappeared". This would seem to indicate that schizo-
phrenia Egg s2 is not the pertinent variable. Knehr (77)
obtained results consistent with Kraeplin in that no differ-
ences in speed of reaction was observed when a group of
schizophrenics were compared with a control group, but H.
King (76) found chronic schizophrenics "clearly less rapid

in psychomotor response when compared with the normal on all
individual subtests of the experimental battery". Equally
differing results have been obtained in studies of condition-
ing in schizophrenic patients. For example, Bender and

Schilder (23) found that "schizophrenics show evidence of

29

conditioning quite as quickly as normal subjects, but the
conditioned response differed considerably". Shipley (107)
reported that schizophrenics both acquired and extinguished
GSR responses more readily than other groups. Results of
both of these studies were confirmed by Malmo and Shagass
(87) whose patients showed a greater responsiveness and
lower threshold of reaction but a lack of discrimination.
Pfaffmann and Schlosberg (95) found no differences between
schizophrenics and normals in conditioned knee jerk. Two
studies by Peters and Murphree (93), on the other hand, dir-
ectly contradicted these findings. Their chronic schizo-
Phr‘enic subjects displayed less autonomic responsiveness to
unconditioned stimuli than did normals and treated patients,
and they also conditioned less readily than either normals
or treated patients. May (88) also found diminished pup-
illary responsiveness to pain and light in schizophrenic
pa-‘l‘oients. Fischer (42) suggested that an "initially abnor-
mally low threshold toward stress is raised during the schizo-
phrenic process to an abnormally high one". A series of
s"Z-udies by Shakow and his associates extending over a period
or years (58, 59, 60, 104, 105, 106) have been devoted to
the investigation of the learning of purposive responses by
schizophrenics. They have found these patients to be most
d~9fective in situations requiring constant voluntary readjust-
Inent but almost normal in performing prolonged, unchanging

tasks. Similarly, Wulfeck (126) found that "speed of

30

 

 

 

adjustment and response is most notably affected" while a
curvilinear relationship seems to exist between the level of
complexity of the task and the schizophrenic's performance
on it. This suggested to Wulfeck "that schizophrenia is a
disease which reduces ability of patients to perform inter-
mediate level motor tasks". Malmo 93 a; (87) in a study of
responsiveness in chronic schizophrenia found "purposive"
overt acts to be less frequent than in normal subjects, but
tension levels of schizophrenics to be higher. Skinner and
his associates at Harvard (50) used a type of vending machine
to study quantity and regularity of "operant" behavior of
chronic schizophrenics under a variety of conditions. An
"Operant response" is viewed by Skinner _e_t_ _a_:l._ as a "behavior-
a1 unit that manipulates part of the environment, represent-
ing as such 'adjustive behavior'". Like Shakow _e_t a; and
M<32er gt a_l_, they found an inverse relationship between the
rate of voluntary manipulative movements and severity of
IDSlirczhosis. Similar conclusions were reached by H. King (76)
in his study of groups of normals, neurotics, "pseudoneurotics"
and. "chronic and severe" schizophrenics divided into three
groupsranging from "least disturbed" to "most disturbed".
He tested their speed of initiating movement in response to
a- buzzer, speed of alternately tapping two metal plates, and
manual and finger dexterity. His findings were that the
chronic schizophrenic groups were "clearly less rapid in

I’Sychomotor response" with greater degrees of retardation

31

becoming apparent as symptomatic expression of psychosis in-
creased. G. King 21 a; (73) found a different state of
affairs in their study of 30 "acute schizophrenic subjects".
Subjects rated as being intermediate in the severity of their
psychosis responded at a relatively higher operant rate than
subjects rated either high or low in severity of illness.
Development of thg Problem

From the studies that have been discussed, it may be
concluded that, despite over half a century of investigation,
theorizing, and speculation, there is still a great diversity
of opinion as to the nature of schizophrenia. The results
01‘ the investigations are inconclusive in some cases and
$3th directly contradictory in others. It is proposed that
a return to investigating some of the formal characteristics
of schizophrenia may prove rewarding at this point. However
C16Blrable it may be to identify the etiology (or etiologies)
of schizophrenia (or the schizophrenias), there is also a
pressing need to know just what we are working with. There
Seems to be good reason for hope that a more precise des-
criptive system will contribute toward understanding and
DeZr‘haps reconciling some of the apparent contradictions in
findings derived from various studies of the disorder. Sig-
1'11 ficant progress in this direction has been afforded by
Ea-I>plications of the process-reactive classificatory concept.
If this essentially longitudinal approach is supplemented

by an intensified cross-sectional one, perhaps much may be

32

ac c ompli shed .

One promising avenue of approach to such a cross-
sectional study is through an investigation of the patients'
motor performance. The argument that movement factors play
a primary role in the adaptation of all forms of animal life
to the environment is too convincing to be easily abandoned.

Frwn the studies that have been discussed, it seems
legitimate to conclude that variations in amount of operant
motor behavior are peripheral rather than essential or "core"
Variables in at least some cases of schizophrenia. While
they give quantitative meaning to the often-expressed ob-
servation that schizophrenia is associated with defects of
Volition, they add little to our knowledge of the essential
characteristics of the disease except in the sense of demon-
8“S-I‘ating that defective conation is a frequent but not in-
vamiable concomitant. In a recent study, Reisman (98) found
e‘Tidence that differences in motivation and work rate within
the schizophrenic group could be predicted from their class-
12E‘lcation as process or reactive. Rather than attempting
to establish how much variation a group of patients show in
their operant responses, perhaps it would be more fruitful
to investigate the factors involved in the variation when it
Occurs. Recent advances in the analysis of motor learning
Provide objective methods for investigating qualitative
clifferences in performance. Applications of such concepts

as temporary work decrement, permanent work decrement, and

33

wgrmegp enable us to speak of the ways in which individuals
vary in their performance where previously we had been con-
fined to measuring the amount of gross variation.

The pursuit rotor task has several advantages to recom-
mend it in studies of this nature: It requires an activity
that is sufficiently different from ordinary life situations
to insure that learning it will be largely unaffected by
prior experience, yet it is simple enough to be easily under-
stood by even relatively confused subjects; and, methods of
isolating the pertinent variables have been worked out and
experimentally validated by a number of investigators. In
addition to this, there is evidence that, given a minimal
amount of compliance on the part of the subject, motivational
factors play little, if any, part in the appearance of the
variables in question (8). Since this evidence was obtained
from a sample of college students, however, it may or may
not hold true for psychotic patients. It was concluded by
Ammons (10), that learning of the movements necessary for
performance on the pursuit rotor "may well involve the
building up of manual and ocular movement patterns of a bal-
listic type". He defined ballistic type movements as "sweep-
ing movements where change of direction takes place in less
than normal reaction time and is consequently not under dir-
ect cortical control". Perhaps related to this factor are
the findings of Brewer gt a; (28) that occurrence of brief

noises during pursuit rotor performance had "no statistically

34

significant di sinhibition or external inhibition effects..."
and that it had no discernable permanent effect on the per-

formance level .

35

Preliminary Study

A preliminary study to investigate the applicability of
the variables involved in the pursuit rotor task to schizo-
phrenic patients was carried out. Prior to beginning the
study, it was necessary to decide at what speed the rotor
should turn. Two considerations were primary in arriving at
this decision: (1) A number of studies have shown that
schizophrenics as a group tend to be slower than most nor-
male on psychomotor tasks, and the degree of their retard-
ati on is directly related to the severity of the illness
(58, 59, 60, 76, 104, 105, 106); and (2) This investigation
was primarily concerned with relationships between variables
rather than with measuring amounts of deviations from "nor-
mal“ performance. Therefore choosing a rotation speed with-
in the capabilities of the particular patient group was of
more importance than choosing one giving direct quantitative
comParisons to other groups. In pre-experimental trials, it
"‘18 empirically determined that patients of the general
PSYChotic level of the sample were most often unable to per-
form the task at the conventional speed of 60 rpm. Many of
the!!! refused to even attempt it. At 45 rpm, however, most
or the patients would attempt the task, and could experience
some success at it.

W2

A Koerth-type pursuit rotor which turned clockwise at

36

 

45 rpm was employed. The rotor disk was black, 28.5 cm. in
diameter, and had a brass target 1.9 cm. in diameter set 8.5
cm. from its center. The styluswas hinged near its wooden
handle so additional pressure could not be exerted on the
rotor disk by "bearing down" on the stylus. Both the brass
target and the rounded tip of the stylus were polished with
fine sandpaper before each subject began practice and at
each five-minute rest period. Two Standard Electric timers
recorded time on target in units of .01 second alternately
every 30 seconds. This was readily accomplished by manual
operation of a toggle switch, the examiner recording time on
target and resetting one time to zero while the other timer
was in circuit during massed trials. Distributed trials and
the final massed trials were terminated by changing circuits
at the same time the examiner said, "stop" in order to pre-
vent accidental continuations of time on target. Similarly,
the signal to begin was accompanied by a changing of circuits I
in order to forestall premature starts upon subjects being

told to "get ready".

W

Each subject was given instructions as to the operation
°f the rotary pursuit device and a demonstration in perform-
ing the task by the examiner. Following this, the subject
was instructed to try it himself. If he demonstrated that
he \mderstood what was to be done, trials were begun immed-
iately. If he showed himself unable to follow the directions,

37

instructions and demonstration were repeated. Six subjects
from the original group of 44 had to be discarded from the
sample due to inability or unwillingness to continue. Mass-
ed practice (M) consisted of continuous practice while dis-
tributed or spaced practice (D) consisted of alternating
intervals of 30 seconds work and 30 seconds rest.
The first of the three practice sessions consisted of

four SO-second distributed trials for all subjects. After a
five minute rest, all subjects were given twelve ISO-second
trials which were massed for half the subjects and distributed
for the other half. Then, after another five-minute rest,
these two groups were again divided with half of each group
being assigned to massed practice and the other half to
distributed practice. Thus there was one group for the first
session, two for the second session, and four for the third.
The conditions of spacing under which the four subgroups
Practiced were: D-D-D; D-D-M; D-M-D; and D-M—M. Each change
01' conditions was accompanied by a five-minute rest, and
Prior to each shift in conditions, the subject was informed
‘31. the change. During distributed practice, the subject
8tibod in front of the rotor during the rest interval. He
was told "pick up the stylus" five seconds before the be-
81lining ; "get ready" two seconds before the beginning: and
"5°" as a signal to start. The subject always began a trial
with the rotor in motion. During the longer rest periods,

the subject sat down and conversed or read, and similar

38

preparatory instructions were given before the start of a new
trial.
Results and Discussion

Scores for the four groups on Trial 1 were subjected to
a sianle analysis of variance as a test that they were random
sanqples from the same population prior to differential treat-
ment. The differences proved to be statistically nonsignifi-
carrt, permitting retention of the null hypothesis. F was
equal to .95 with 3 and 36 degrees of freedom.

The performance curves for all groups are plotted in
Fiégure l. The expected superiority of distributed practice
ovwsr massed is immediately observable. Next, straight lines
wears fitted to the curves in Figure l by the method of aver-
age decrement as suggested by Ammons (6, 7), and the straight
111168 were extrapolated forward and backward to estimate
Whiit the scores on adjacent trials would have been had there
been no rest. From these data, calculations of warm-up,
temporary work decrement, and permanent work decrement were
made. “a“ in the figure is the total temporary decrement
following distributed conditions and represents 2.87 seconds
of time on target. "B" is warm-up decrement under the same
conditions, and this represents 2.23 seconds or 78% of the
total temporary decrement. If temporary work decrement is
corrected for warm-up decrement, only a negligible amount
(0.64) remains. This was interpreted as indicating that

temporary work decrement (or reactive inhibition) did not

39

HMQRJbra 20 COUZOOMU)

21

20

19 a 1.777.;

H
.q

H H
5 5; m m

P‘
N

11

10

1

 

TRIALS
Fig. 1. Performance Curves anfiovariables, Preliminary study.

build up under these conditions, and the performance curve

of tlie distributed group can therefore be regarded as approx-
imating the optimal performance of this sample. “C", repres-
entiamg 8.22 seconds, is the amount of temporary decrement,
following massed practice, and"9“, representing 4.99 seconds,
is iflhe amount of warm-up decrement under the same conditions.
Temporary work decrement corrected for warm-up decrement is
3. 23 seconds following massed practice. Finally, "E" is the
difference between distributed practice and massed practice
which does not dissipate spontaneously over rest and is
therefore a measure of permanent work decrement or condition-
ed. inhibition. This amounts to 2.12 seconds in the present
Gates.

‘The above findings indicate that the variables developed
f170m pursuit rotor studies are applicable to the study of
schizophrenic patients. They also indicate that distribution
017 practice by 30-Seconds work and BO-seconds rest is ef-
ikective in preventing accumulation of temporary work decre-
xmant in patients of this level of psychosis. It is to be
‘noted, however, that this group averaged somewhat higher
scores at a rotor speed of 45 rpm than normal groups show at
60 rpm. Conclusions as to the relative effects of the

various factors are reserved until further comparisons can

be made .

41

 

main Study

In the foregoing discussion, it was pointed out that
clamssification of schizophrenic patients as Process or Re-
actisve provided a meaningful additional description of them.
Altkiough most of the earlier investigators conceived of
process and reactive schizophrenia as a dichotomy, several
recent investigators have advocated the use of a continuum
aPExroach. A number of factors, both empirical and theoreti-
caJL in nature, make the continuum concept appear more advan-
taigeous. In the first place, it fits clinical observations
more closely. As was mentioned earlier, differences of
Opinion as to whether or not a particular person is schizo-
Phurenic are not unknown. Such a person might be regarded as
near one of the end points of the schizophrenic distribution.
Wisthin the unequivocally schizophrenic group, it is rare to
fiJmi a case where the patient's history and symptomatology
place him completely within one or the other of the two cate-
gories. It follows that the continuum is better suited for
experimental purposes than is a dichotomy. Whether the over-
lap between the two groups is attributable to the relative
crudity of our measuring instruments or to the nature of
schizophrenia, it nevertheless is uniformly found. A con-
tinuum permits the eXperimental use of many patients who
would otherwise fall into an indeterminate "mixed" category.

At the same time, it avoids a "forced choice" situation

42

where truly borderline individuals must be placed in one
group or the other, thus increasing the chances of obscuring
the results. From the standpoint of theory, the continuum
idea again seems to be more desirable since it adapts itself
well to a greater number of theoretical considerations than
would a dichotomous approach. A theoretical explanation of
the continuum could be, for example, along the lines of
Meyer's (91) concept of psychobiological interaction, or of
Bellak's (22) psychogenicity-organicity theory, or a purely
psychological one such as Becker's (19). For these reasons,
it was decided to use a process-reactive continuum in rating
the schizophrenic patients included in this study. The next
step, then, was to choose a method of doing to. Becker's
(19) revision of the Elgin Prognostic Scale was chosen after
consideration of the possible advantages and disadvantages
connected with it.
Eggposes g§_§hg_lnvestigation

The present study was undertaken in an attempt to secure
additional evidence concerning the validity and practicality
of the concepts of process and reactive schizophrenia: A
study of modes of adjusting in a motor learning situation
was chosen as a means of obtaining an objective cross-
sectional sample of adjusting processes in these psychotic
groups. Variables derived from studies of pursuit rotor per-
formance by normal subjects offered convenient tools for

accomplishing this purpose and were therefore adopted in the

43

present investigation. These variables are: temporary in-
hibition (reactive inhibition, temporary work decrement),
conditioned inhibition (permanent work decrement), and warm-
up or set.

The present investigation was designed to make use of
the findings by Weaver (117), Reynolds and Adams (99), and
Denny 23 g; (35) in their studies of the performance of
normal subjects.

Methodology

The procedures of Denny gt a; (35) were duplicated with
the exception that the rotor was turned at 50 rpm in the
present study whereas the above authors used a rotation
speed of 60 rpm. This reduction in rotor speed was considered
advisable because of the inability or unwillingness of many
psychotic subjects to perform at the more rapid pace.
Apparatus

The experiment was conducted in a quiet room, nine by
twelve feet in size, on the second floor of the hospital
ward. ‘Windows along one wall gave a view of only another
building approximately two hundred yards away. Further il-
lumination, when needed was furnished by a 150 watt bulb
above and slightly to the rear of the subject. The same
physical equipment that was used in the preliminary study
was utilized in this investigation.

Subjects
Eighty male patients in a VA neuropsychiatric hospital

44

made up the sample for this study. All the psychotic sample
was chosen from patients assigned to the Acute and Intensive
Treatment Service of the NP hospital. Three hundred fifty
two case histories of schizophrenic patients were examined.
From these, a total of 176 were chosen on the basis of their
having sufficient material to allow rating on the Elgin
Prognostic Scale; no history of brain injury or long periods
of unconsciousness; diagnosis of psychosis made within the
past year; a history free of repeated hospitalizations over
the past 10 or 12 years for neuropsychiatric reasons; and
definite evidence of the presence of gross schizophrenic
symptoms such as hallucinations, delusions, ideas of reference,
and bizarre behavior.

As was stated earlier, the device chosen for distin-
guishing between process and reactive patients was Becker's
modification of the Elgin Prognostic Scale. The Elgin Scale
was devised by Wittman (122) and first used by her at the
Elgin State Hospital. Becker's revision of it (see appendix)
consists of twenty statements. Each statement is subdivided
into a number of items describing more specifically the de-
gree to which the statement is applicable to the person being
rated. Each of the sub items is assigned a numerical value,
and the scores of all items are summed to arrive at the per-
son's total score. Wittman, on the other hand, had used only
end points to rate each statement. Becker's addition of

intermediate values was designed to "add to the precision of

45

rating" (19). Disadvantages of the scale include a probab-
ility of unequal discriminatory ability among the various
items and certain departures from the rules of good scale
construction. For example, there are different ranges in

sub scale numerical values from item to item. Becker's own
observation that the scale is curtailed and not discriminat-
ing enough at the "normal" end appears to be valid. The
advantages, however, seemed to far outweigh the disadvantages.
Wittman's original use of the scale (122) showed a two-rater
reliability of .87, and subsequent studies (75, 123) showed
it to be highly valid as a prognostic instrument. Becker's
modification seemed to offer an even greater degree of exact-
ness in rating, and at the same time, to permit a grading
along the entire length of the continuum. Therefore it ap-
peared more suited to a continuum frame of reference than

did Wittman's original scale or the method of selection

used by Kantor g§_§;_(67). In a study reported by MbDonough
(84), the present writer and MhDonough had a two-rater relia-
bility coefficient of .89 in rating subjects by use of this
scale.

Figure 2 presents the ratings given the 176 patients in
the present study on Becker's modification of the Elgin
Prognostic Scale from case history material and records of
behavior since hospitalization. It is readily observable
that the distribution of ratings approximate a normal curve.

The reactive sample was taken.from the low-score, good

45

 

 

 

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Fig, 2. Ratings on Elgin Prognostic Scale assigned to
population from which psychotic samples were drawn.

47

prognosis end of the distribution and the process sample
from the high-score, poor prognosis end. A brief description
of the two groups follows.
The process group consisted of 40 patients ranging in
age from 19 to 39 years. The mean age was 28.6 years.
thirty one of the group were white and nine were Negroes. a
Diagnoses included 26 schizophrenic reactions of the un-
classified type, nine paranoid type, two catatonic type, two
simple type, and one mixed paranoid and catatonic. Jl
From the group with the 40 highest scores on the Elgin
Scale, qualifying them for inclusion in the process sample,
a total of four were not used. Two of these were transferred
to another hospital, one was too confused to cooperate, and
the other refused to leave his ward. The next four high-
scoring patients were substituted in their stead.
The reactive patients ranged in age from 24.5 to 44
years and had a mean age of 31.8 years. This group also was
composed of nine Negroes and 31 whites. Diagnoses included
29 schizophrenic reactions, unclassified type; 6 paranoid
type, 2 schizo-affective type, and 3 catatonic type.
Four of the group of 40 scoring lowest on the Elgin
Scale were discharged from the hospital between the times of
rating and testing, and one refused to continue after com-
pleting the first practice session. These five patients
were replaced in the sample by the five having the next-

lowest ratings. Seven other reactive patients received

48

passes of a few days duration between the times of rating
and testing, but returned in time to be included in the sample.

The relative fluidity of the reactive patient population
imposed difficulties in obtaining the sample. On the other
hand, this served as an incidental indication of the validity
of the scale as a prognostic instrument.

As the patients were tested on the pursuit rotor, they
were also rated by the examiner in regard to apparent degree
of psychosis at that time. An example of the scale used is
included in the appendix. The ratings were accomplished
simply by checking the point on a straight line at which the
particular patient seemed to fall and they were made on the
basis of the patients' behavior during the testing and con-
versational offerings during the two five-minute rest periods.
It should be emphasized that these ratings were more or less
subjective on the part of the examiner, and no attempt was
made to probe into the patients' deeper feelings or thought
processes.

After all patients had been rated, the rating sheets
were ranked in order from least to greatest amount of psycho-
sis apparent. No attempt at quantification was made. Next,
White's Rank Test (40) was applied to determine whether or
not patients in one of the schizophrenic categories had ap-
peared more disturbed than the other. Results of these cal-
culations are given in Table 1. As can be seen, the differ-

ence did not approach statistical significance and it would

49

not have done so even if a one-tailed test had been applied.
In other words, both groups of patients appeared to the ex-
aminer to be about equally disturbed.

It should also be noted that some of the patients in
this sample were being treated with tranquilizing drugs.
Amount and rate of drug dosage were in accordance with the
regular hospital treatment program and were prescribed by
the ward physicians. A check was made as to whether or not
this treatment could be expected to vary with respect to the
two schizophrenic groups in this study. Ten subjects each
were chosen at random from the two groups, and their medi-
cation records were checked for the week preceding testing.
Four process patients and three reactives were being given
Thorazine. The average daily dosage was 300mg. in each case.
One patient in each sample was being given Trilafon with the
process patient being given 12 mg. daily and the reactive
8 mg. Six reactives and five process patients were not given
medication during the week preceding testing. From this
small sample, it would appear that the two groups were not
given differential drug treatment.

Twelve normal subjects were run at 50 rpm in order to
be sure that the reduced rotor speed pg; s2 introduced no
new variables. The normal group was composed of hospital
employees comparable in age to the psychotic group.

All testing on the pursuit rotor was done by the in-
vestigator between the hours of 9:00 AM and 4:00 PM.

50

Each of the two main groups (process and reactive) was
subdivided into four subgroups making eight in all with 10
subjects in each group. The conditions of spacing under
which the four groups from each category practiced were:
D-D-M; D-M~M; MrD-M; and M-M-M. For purposes of easy refer-
ence, the reactive schizophrenic group will hereafter be
referred to as R-D-D, R-D-M, etc. While the process schizo-
phrenics will be referred to as P-D-D, etc. Since all
groups were massed for their final session, only the first
two practice conditions differentiate the groups. Instruc-
tions to subjects were identical to those given in the pre-
liminary study. The first session in each case consisted of
twelve BO-second trials; the second of eighteen BO-second'
trials; and the third of six 30-second trials. The third
session was massed trials for all subjects. The normal group
practiced under conditions of M-D-M for the same time periods
as did the psychotic S's. Time on target was recorded every
10 seconds for the first two minutes of sessions 1 and 2,
and for all of session 3. Otherwise, it was recorded every
30 seconds, and the method of accomplishing this was the
same as that previously used in the preliminary investigation.
SubJects in each of the two main categories were roughly
matched in assignments to the four practice conditions on
the basis of their performance during the first 30 seconds
or practice. This was accompliShed by a quick estimation

and Without interrupting the practice in any way. The

51

graphs in Figures 5 and 6 and the statistical analysis in

Table 2 (see Results section) give evidence that the groups

were well matched at the beginning of practice. Scores of

time on target of the normal sample were converted into per-
centage of time on target in order to facilitate comparisons
with other published data.

Analysis of variance was used as the statistical tech-
A fundamental

‘ ‘W——“* '1” WE:-

nique for comparisons whenever appropriate.

condition for the validity of this procedure is that the l
_L

mean squares be independent. This condition is not met in

the case of percentages. Calculations of differences between

the psychotic groups were therefore made from the raw scores

rather than from percentage scores. In each case where

analysis of variance was used, a test of homogeneity was
first applied as recommended by Edwards (40) to assure that

the data were sufficiently homogeneous to make the F test

applicable.
In cases where analysis of variance indicated that sig-
nificant differences existed between the groups, Tukey's

Gap Test (40) was applied. This test tells how great a dif-

ference has to be in order to be considered statistically

significant at a pre-determined level. When mean scores are

arranged in order of magnitude, gaps between them can then be

easily checked to determine whether or not they are statisti-

cally significant. In the present study, statistical signifi-

cance was arbitrarily placed at the .05 level unless it is

52

otherwi as indi cat ed .

53

. “it?“

‘r‘ n? _mfix?
.

RESULTS

The mean scores of time on target of the normal sample

are presented in Figures 3 and 4. Inspection of the curves

reveals that, although this group started at a higher level

and continued to achieve better scores than samples run at

60 rpm, the same variables appear. Massed practice during

learning was characterized by rapid growth in skill at first.

Then inhibitory factors set in, the curve became negatively

accelerated, and then took on a downward trend. After a

five-minute rest, significant reminiscence was shown, indic-

ating that an appreciable amount of inhibition had dissipated

over rest. The post-rest practice periods were marked by an

initial spurt of warm-up, and then continued in a pattern
characteristic of the conditions of spacing or massing. It
can be concluded that the slower rotation speed of 50 rpm
does not eliminate any of the usual variables encountered in
motor learning situations and does not introduce unusual
variables into the situation.

TABLE 1

White's Rank Test Applied to Estimated Degree of
Psychosis in Process and Reactive Patients

 

 

Mean Standard 2 P P
Group Sum of Ranks Rank Deviation score .10 .05
Process 1765

1620 103.75 1.40 1.65 1.96
Reactive 1475

 

54

 

1:1. I I i‘i‘."li.

 

0 0 o 0 0 0
8 7.. 6 5 2 .1.
PERCENT TIME TIARGET

Asalguide in considering the results obtained from the

psychotic samples, several specific questions were formulated

wimarespect'to each dependent variable. These questions are:

1.

2.

7.

Do process and reactive schizophrenics differ regard-
less of conditions of practice?

Do they differ on massed practice when this is the ,
initial practice condition? a

Do they differ on spaced practice when this is the .
initial practice condition? L

?o they differ on spaced following spaced practice
D-D 7

?0 they differ on massed following spaced practice
D-M ? .

 

?0 they differ on massed following massed practice
M-M ?

?0 they differ on Spaced following massed practice
M-D 7

The dependent variables by means of which the two

psychotic samples were compared were: scores of time on tar-

get, reminiscence, temporary inhibition, conditioned inhibi-

tion, amount of warm-up decrement, and length of time taken

to warm up or regain set after a rest. Each of these varia-

bles was discussed in general terms in a preceding section.

Operational definitions of each as they are used in the pre-

sent study are given together with the results in each case.

Time on target was simply the scores recorded for each

subject.

Scores for all trials within a designated period

were summed for each subject. In this way, cumulative scores

for each were obtained for the period being investigated.

57

Mean times on target for all practice sessions of the

psychotic samples are presented graphically in Figures 5 and

6.
Analysis of variance of time on target scores for the

first practice period is presented in Table 2. Since all

TABLE 2

Analysis of Variance of Total Time on Target,
Last Half of Practice Period 1

 

 

 

Sum of Mean
Source of variation squares df Square F P
Between conditions 8724.08 1 8724.08 13.10 .01
Between diagnoses 571.27 1 571.27 0.86 NS
0 x D interaction 2733.13 1 2733.13 4.10 .05
Within groups (error £616.52 _7_6__ 666.01
Total 62645.00 79

 

For df l and 76, F.05 = 3.97 F.01 : 6.98

groups were matched at the beginning of practice, the analy-
sis of variance which is presented here was calculated over
the second half of the practice period. This approach was
chosen since it is the conventional method of bringing out
more clearly any differences in scores associated with dif-
ferent conditions of practice. It should also be noted that
only four groups are involved in this analysis since each
psychotic group was divided equally into spaced and massed
gro_ips for the first practice session.
A graphic presentation of the scores of these four

groups is given in Figure 7.

58

 

 

59

Fig. 6. Process groups, mean time on target

It’ll-Ill

       

H

 

|--‘

H

 

.........

\0

co

 

  

3 5 6 7 8 9 10 11
Fig. 7. Mean times on target, first practice period
60

   

12

The superiority of groups practicing under distributed
conditions over groups practicing under massed conditions is
clearly evident, and this superiority is significant beyond
the .01 level (F = 13.10 with l & 76 df). This phenomenon
was one of the first observed to be typical of normal sub-
jects in motor learning tasks. It's appearance in the psy-
chotic samples is therefore to be expected.

Of more importance to the present study is the effect
of spacing and massing upon the two psychotic types. There
proved to be a significant interaction effect between type
of psychosis and condition of practice. The reactives re-
sponded quite differently under the two conditions of prac-
tice while the process groups showed no statistically sig-
nificant difference between conditions. Whereas the RD
group scored higher than any of the others, the Rm group's
performance fell below that of all the others'. Tukey's gap
test for significance of differences between adjacent means
(Table 3) indicates that the RD groups' performance was
better than the PD group's beyond the .05 level of signifi-
cance. The difference between the PM and RM groups was in
the opposite direction, but was not statistically different.
A striking feature of the data is that, while the PD group
surpassed the PM group in performance as would be expected,
the difference between the groups did not reach statistical

significance in this first practice period.

Partial answers to our first three questions are as

61

TABLE 3

fiflflfiJs Gap Test Applied to Differences in Time on Target
Last Half of Period 1

 

 

 

 

Groups Mean time on target Difference
RD 73.10
PD 56.56 16.54* a
PM 47 . 27 11 . 29 I?
RM 41 .02 6. 25 '
A significant gap 2 16.21 .
L

follows:

1. No significant differences in motor performance ap-
peared between the two psychotic types pg; g3 (Between types
F = 0.86 with l & 76 df).

2. The psychotic groups did not differ significantly
under initial massed practice.

3. Reactives were significantly (.05) superior to
process on initial spaced practice.

Table 4 presents the analysis of variance of time on
target scores for the second practice period. Again analysis
was computed on the last half of the practice period in order
to test more adequately the relationships involved. The
reasoning,here is that after the first few minutes of post-
rest practice (about ‘2i- to 3 minutes for normal subjects)
differences due to reminiscence and warm-up have been com-
pensated for, and relationships then become more stable. In

addition to this, the last cross-over of performance curves

62

TABLE 4

Analysis of Variance of Total Time on Target,
Last Half of Practice Period 2

 

Sum of Mean
Source of variation squares df square F P

Between conditions 35295.66 3 11765.22 5.93 .01

 

 

 

Between psychotic types 0.00 l 0.00 0.00 NS
C x T interaction 3891.55 3 1297.18 0.65 NS
Within groups (error)l4g922.45 72 1985.03

Total 182109.66 79

 

 

arising from changes in conditions had occurred by the mid-
point of the practice period (Adams & Reynolds (2), Denny
(34), Frisbey (45), and Reynolds & Adams (99) have found

that the performance curves of normal subjects practicing

 

under similar conditions come together and merge into a
single curve after about six minutes regardless of previous
conditions of practice).

As can be seen from Table 4, differences arising from
conditions of practice were significant beyond the .01 level.
Interaction between psychotic categories and conditions of
practice were no longer significant, however, and differences
arising from process versus reactive schizophrenia pg; g2
were nil. The significant F primarily reflects the fact that
the groups under massed practice did not merge with each
other in either psychotic sample. The RDM group scored

consistently higher than the REM group, while the PDM group

63

scored consistently lower than did PMM. These differences

were tested by means of the 1.; test, and the results are given

in Tables 5 and 6. Group RDM surpassed group RMM at a level

of significance beyond .01. Group PDM fell below group PMM,

but not to a statistically significant degree.

TABLE 5 P

%
‘2 Test of Differences in Time on Target l
Between Groups RDM and RMM, 1

Last half of Practice Period 2

 

 

 

 

 

 

RDM , )3

Mean 111.78 90.58

Standard error of difference 3.37

between means

2. 6. 29*

(11‘ 18

P .01

For 18 df, P.01 = 2.88

 

TABLE 6

2 Test of Differences in Mean Time on Target Between
Groups PDM and PMM, Last Half of Practice Period 2

 

 

PMM PDM
Mean 98.89 87.47
Standard error of difference 19.36
between means
3 .59
(if 18
__P NS

 

64

Another kind of difference is seen in the performance
cfi'the two DD groups. Whereas during the first practice
period the RDD group had outgained the PDD group by a sig-
rniicant (.05) amount, the situation appears to be reversed
in.the second period. The performance curve of RDD appears
essentially flat while group PDD seems to rise in a relatively
straight line. This impression was tested by a method sug-
gested by Edwards (39). Gains for each group between the
first minute of practice in the second period and the last
minute of the same session were computed and the differences
in gain subjected to a 3 test. Results, presented in Table
7 demonstrate that, during this practice period, group PDD
outgained group RDD by an amount significant beyond the .05
level.

TABLE 7

3 Test of Differences in Gains Between Groups RDD and PDD
From First to Last Nhnute of Practice Period 2

 

 

 

RDD PDD
Mean 12.60 18.14
Standard error of difference 2.32
between means
jg 2.39"r
df 18
P .05
_ For df 18, 19.05 -_- 2.10 13.01 -_- 2.88

.Answers to our original seven questions which would be

made on the basis of the second practice period scores are:

65

l. The two schiZOphrenic groups showed no difference in
time on target attributable to the psychotic category 22£.§2
(F = 0.00).

2. They differed to a significant (.05) degree in re-
action to DD conditions of practice with process groups out-
gaining the reactives.

3. They differed to a significant (.01) degree in res-
ponse to DM conditions. Reactives showed an elevation effect
when compared to the MM group, and the process subjects Show-
ed a disruption of performance.

4. They showed no significant differences in response
to MD conditions. Both groups showed something of an elev-
ation effect when shifted to D conditions and slightly sur-
passed the groups that had been under spaced conditions from
the beginning.

Time on target during the third, and last practice
period when all subjects were under the same conditions of
practice was subjected to analysis of variance, and the re-
sults are presented in Table 8. As can be seen no signifi-
cant differences in time on target persisted at this time.
All groups had arrived at a comparable level of performance.

Reminiscence, or gain over rest, was operationally de-
fined in this study as the difference in time~on-target
scores between the last 30 seconds of pre-rest practice and
the first 30 seconds of post-rest practice. To obtain

reminiscence scores, differences in performance were calculated

66

 

TABLE 8

Analysis of Variance of Time on Target
During Practice Period 3

 

 

Sum of Mean
Source of variation squares df square F P
Between.conditions 162.60 3 54.20 0.05 NS
Between diagnoses 1.07 1 1.07 0.00 NS
0 x D interaction 3128.92 3 1042.97 0.93 NS

Within groups (error) 81059.25_, 12 1125.82
Total 84351 . 84 79

individually for each subject. Analysis of variance of

reminiscence scores over the two five-minute rest periods

are given in Tables 9 and 10. As can be seen, the only

difference that proved to be statistically significant

arose from different conditions of practice during the second

practice period. These were in the usual direction with

TABLE 9

Analysis of Variance of Reminiscence
Over 1st Rest Period

 

 

 

Sum of Mean
Source of variation squares df square F P
Between conditions 46.57 3 15.52 2.06 NS
Between diagnoses 0.04 1 0.04 0.01 NS
0 x D interaction 31.25 3 10.42 1.38 NS
Within groups (error) 542.11 12 7.53
Total 619.97 79

 

For df 3 a. 72, s05 : 2.74 am ; 4.08

67

 

1r”:’:.mtw

 

TABLE 10

Analysis of Variance of Reminiscence
Over 2nd Rest Period

 

 

 

Sum of Mean

Source of variation squares df square F P
Between conditions 222.45 3 74.15 6.59 .01
Between diagnoses 6.80 1 6.80 0.60 NS
'6 x D interaction 64.95 3 21.65 1.92 NS
Within groups (error) 810.08 png_ 11.25
Total . 1104.28 79

For df 3 a 72, F.05 : 2.74 F.01 = 4.08

subjects massed in the second practice period showing more
reminiscence than subjects who had been assigned to distrib-
uted practice during the preceding period.

It is worth noting, however, that the performance curves
in Figure 5 depict the RDD group as showing an appreciable
amount of gain over the second rest period in comparison
With the other groups. Over the first rest period, they
showed a negligible amount of gain. This is a bit of evid-
ence in support of the interpretation to be developed later
that group RDD did not find apaced conditions noxious during
the first period, but did react negatively to being continued
on spaced conditions. The two psychotic groups did not ap-
pear to differ in any other way with respect to reminiscence.

.Amount of warm-up decrement was operationally defined

as the difference between the first 30-second post-rest trial

68

and the peak score of the post-rest spurt. Warm-up decrement,
like reminiscence, was computed separately for each of the
80 subjects.
Analysis of variance of warm-up decrement for the two
post-rest practice periods are presented in Tables 11 and 12.
TABLE 11

Analysis of Variance for Amount of Warm-Up Decrement
at the Beginning of Practice Period 2

 

 

 

Sum of Nban
Source of variation 'squares df square F P
Between conditions 13.09 3 4.36 1.99 NS
Between diagnoses 1.28 l 1.28 0.58 NS
0 x D interaction 5.11 3 1.70 0.78 NS
Within groups (error) 151.22 _12_ 2.19
Total 177.27 79
For df 3 a 72, F.05 = 2.74 F.01 ; 4.08
TABLE 12

Analysis of variance of warm-Up Decrement
at Beginning of Practice Period 3

 

 

 

 

Sum of Mean

Spurce of variation squares df square F P
Between conditions - 12.44 3 4.15 2.99 .05
Between diagnoses 0.00 1 0.00 0.00 NS
0 x D interaction 6.61 3 2.20 1.58 NS
Within groups (error) _199.25 _72 1.39
Total 119.30 79

For df 3 & 72, F.05 = 2.74 F.01 = 4.08

59

again, the only differences of statistical significance were
those brought about by the conditions of practice. The two
groups undergoing massed practice for both preceding practice
sessions showed more warm-up than did groups with spaced
practice experience. Presumably, groups under spaced con-
ditions would have had more practice in resum ng the task
after a rest, so the observed difference is in the expected

direction. This 18 also the usual finding in studies utiliz-

ing normal subjects With the exception of the Frisbev study

 

(45) after which the present study is chiefly modeled. No
differences in amount of warm-up decrement were found between
the two psychotic groups. This finding is worthy of special
note since it will be referred to in discussing the length

of time taken to warm up by the two psychotic groups.

Time.required to warm-up was operationally defined as

 

the number of lO-second units of practice taken to reach the'
peak of the post-rest spurt in performance. Scores for each
subject were arrived at by counting. Since measurements

were not made for periods under 10 seconds, a normal distribu-
tion of scores could not be expected. Analysis of variance
could not, therefore, be appropriately applied to these data.
Instead, a simple sign test recommended by Edwards (40) was
utilized. The Z-scores presented in Table 13 are corrected
for continuity since it is to be eXpectcd that the underlying
variable, (length of time to warm up) was normally distributed.

This correction has, in every case, the effect of lowering

70

TABLE 13

Time to Warm Up, Beginning of Second Practice
Period Z-Scores for Differences Between Groups

 

PMM PMD PDD PDM RMM RMD RDD
PMD 0.00

 

PDD 1.27 0.32

Pow 2.22** 0.32 -0.32

REM 0.63 0.53 ‘1.58* -0.95

RMD 0.00 0.95 ‘0.32 -O.95 0.00

RDD 2.00** 2.00** 0.32 0.00 0.32 1.58

RDM 5.70*** 2.00** 0.95 0.00 0.95 0.95 0.00
* Significant beyond .10 level.

** Significant beyond .05 level.
*** Significant beyond .01 level

 

A minus Z-score indicates that the group in the left
hand column took longer to warm-up than the group in
the top row with which it is compared.

Z score of all PM - all RM 1.79*

z score of all PD - all RD 2 0.67
2 score of all P - all R a 1.90*

the probability of finding significant differences. Inspec-
tion of Table 13 reveals that, when all process patients are
compared with all reactive patients, the process group took
longer to warm up. This difference is significant beyond the
10 percent level of confidence but does not reach the .05
level. Beyond this, the differences found are not meaningful
for this study. The groups which had practiced under massed
conditions took longer to warm up or regain set than did the

distributed-practice groups. Normal subjects show the same

71

effects from spacing and massing.

Temporary inhibition was operationally defined as remin-
iscence plus warm-up decrement. This measure was obtained
by adding together the scores for each subject. The aim
here, of course, is to obtain an estimate of what the gain
over rest (assumed to be from dissipation of temporary in-
hibition) would have been had there been no need to warm up.
Analysis of variance of temporary inhibition dissipated over
the two rest periods are given in Tables 14 and 15. Over the
first rest period, as can be seen, there was a difference at
the .01 level of significance between groups practicing
under massed and spaced conditions. This difference is in
the'usual direction with massed practice groups showing the
:most inhibition dissipated over rest. Differences due to
psychotic type or to interaction of psychosis and conditions
of practice did not approach significance.

TABLE 14

Analysis of Variance of Temporary Inhibition Dissipated
Over the First Rest Period

 

 

 

 

Sum of Mean

Source of variation squares df square F P
Between conditions 117.85 3 39.28 4.43 .01
Between diagnoses 1.29 l 1.29 .15 Ns
C x D interaction 15.78 3 5.26 .59 NS
Within groups (error) 638.15 _12__ 8.86
Total ' 773.07

JFor df 3 & 72, F.05 = 2.74 F.01 : 4.08

72

TABLE 15

Analysis of variance of Temporary Inhibition
Dissipated Over Second Rest Period

 

 

 

Sum of Mean
Source of variation squares df square F P
Between conditions 281.72 3 93.91 7.83 .01
Between types 10.73 1 10.73 0.89 NS
C x T interaction 82.57 3 27.52 2.29 NS
Within groups (error) 864.24 12 12.00
To tel 1239. 26 79

 

For df 3 a 72, 3205 ; 2.74 10.01 = 4.08

Over the second rest period, the same results were ob-
tained with a single exception. The differences due to
interaction barely missed significance at the .05 level.
Inspection of Figures 5 and 6 again reveals that the RDD
group was the only one apparently deviating from normal ex-
Pectancies with respect to gain showed over the second rest
Period. This suggests that the interaction effect arose
largely from the improved performance of the RDD group.
Normally, spaced-practice subjects are expected to show
little, if any temporary inhibition.

Conditioned inhibition was operationally defined as the
difference between spaced-practice subjects and massed-Prac"
tice subjects on the first post-rest 30-second trial with
I"r""“'1"m~up decrement added to the score in each case. Statisti-
Cal analysis in this case consisted of applying the t test

1.3 .
o differences between the two groups from each psychotic

73

 

 

 

sanmflxe. That is, group PD was compared to group PM and

(group RD was compared to group RM. For the first trial of

practice period 2, there were 20 pairs of subjects in each

psychotic category. The first trial of period 3 provided
a

10 pairs each of reactive and process patients for comparison.

The results shown in Tables 16 and 17 demonstrate that a

 

statistically significant amount of conditioned inhibition
was found after the first practice session for both groups.

1
t the beginning of the third practice session, however, con- if

’1?» -
Ja—

ditioned inhibition was not found in either case.
TABLE 16

,3 Test for Conditioned Inhibition
Following First Practice Period

 

 

 

RD RM PD PM

Mean 15.12 10.69 13.11 11.60
Standard error of

difference between 1.61 1.51

means

3 2.75 1.00

df 18 18

P .05 NS

For 18 df, 2.05 : 2.10 P.01 ; 2.88
74

TABLE 17

 

 

    

 

 

3 Test for Conditioned Inhibition
Following Second Practice Period
RDD RMM PDD PMM
r-ioan 18. 22 16. 51 17.11 16. 54
Standand error of i
difference between 4.93 1.79 !
means i
3; 0 . 35 0 . 32 7
df 8 8 g
p, _ ..
For 01f, P.05 - 2.31 P.01 - 3.36

 

75

DISCUSSION

This experiment began in an attempt to gain more infor-
nntion about process and reactive schizophrenics. A.study
of'modes of adjusting in a motor learning situation was

chosen as a means of obtaining an objective cross-sectional

sample of their adjusting processes. Variables derived from

studies of pursuit rotor performance by normal subjects of-
ofered convenient tools for accomplishing this purpose and
were therefore adopted in the present investigation.

The very fact that the investigation was undertaken
implies, of course, that differences between the two psychotic
groups were expected, although no specific hypothesis were
formulated. Indications that differences do, indeed, exist
are given by the learning curves of the psychotic subjects

under the various conditions of massing and spacing of

Statistical evidence gives considerable assurance
As will

practice.

that these differences did not happen by chance.

appear later, there was also a high degree of consistency

among the various factors.

.A finding of primary importance was that all the psy-

<flrotic groups arrived at a comparable level of skill at the

task after 18 minutes of practice. This neatly demonstrated

that the differences cannot be attributed to a deficit in

psycho-motor performance by one of the groups. As well as

providing corroborative evidence for the same conclusion

76

 

added weight and meaningfulness to the results of the present

investigation.

 

arrived at by Heisman (98) in his study, this finding gives W

Performance of the subjects during the first practice
period indicated that the reactive patients were more strong-
ly ormore immediately affected by differences in the environ-
mental situation. The reactive group under spaced conditions
surpassed all other groups at a significant level while the

RM group fell below all the others. That the difference

 

arose from immediacy of response on the part of the reactives
was indicated by several independent lines of evidence in
the later practice periods. First, by the end of the second
practice period there were no longer any statistically sig-
nificant differences between the PDD and RDD groups or be-
tween the PMM and the RMM groups. As a matter of fact, both
process groups which were spaced for the second practice
period now slightly surpassed both reactive groups under the
same conditions. It will be recalled that in the first
session, the process groups had been significantly lower

and that the PDD group made significantly more gain during
practice period 2. Another line of evidence is found in the
longer time taken by the process group to warm up or regain
their set after a rest. That this was truly a relative
slowness in regaining set is indicated by the fact that the
total amount of warm-up shown by the process patients did

not differ significantly from the amount shown by the

77

reactives. In other words, it appears that the process sub-
Jects simply took a little longer to arrive at the same stage
reached more quickly by the reactives. Still another bit of
evidence is supplied by the lack of difference in reminis-
cence over the let rest between the two main psychotic groups.
Associated with this, of course, is also the lack of differ-
ence in temporary inhibition dissipating over rest between
practice periods 1 and 2. This would indicate that the
process patients were not experiencing massed conditions as
either more or less noxious than the reactives did.

Upon further analysis of the data, it begins to appear
that there were not only differences in speed of adapting to
the task, but also differences in kind. Early indications
of this were given by the elation effect shown by reactive
patients upon any change of conditions, even to more noxious
ones. This suggests an attempt at escape; a pattern of
flight from present circumstances into new situations. Add-
ed liklihood for this interpretation was provided by comments
of RDD patients during their second period of spaced practice
that they were “bored", "tired", etc. Their performance
bore out their verballzations quite well since this group,
superior in performance in session 1 when the task was novel,
fell below all the other distributed-practice groups in
session 2.

Following a second five-minute rest, the subjects were

told that the next session would be massed. The RDD group

78

 

 

then demonstrated that they were not deficient in either
ability or learning. They showed a reminiscence effect that
was comparable to that shown by the previously-massed groups,
then continued to perform as well as the other seven groups.
The same interpretation of a flight reaction could ex-

plain the performance of the RDM group. Upon being shifted

 

from D to M conditions for the second session, they showed
an elevation effect and surpassed the RMM group by a sig-

nificant amount. The probability of an aversive response to

 

the on-going state of affairs is pointed up more forcefully
by the fact that, during the first practice session, groups
RDD and RDM were statistically indistinguishable.

While these shifts were taking place, the RMM group
continued to be lower than any other. Following the second
five-minutes rest, however, it became evident that massing
of practice throughout had not been reacted to by this group
as being oppressive. They showed a moderate amount of
reminiscence over rest, a moderate amount of reactive in-
hibition, and they warmed up quickly in the third practice
period. They also performed at a level that was not sig-
nificantly different from the other seven groups When all
were practicing under the same conditions in practice period
3.

At first glance, we seem to be faced here with a per-
plexing contradiction. The RDD group, under presumably

least noxious conditions, reacted in the second p actice

79

period as though these conditions were oppressive. at the
same time, the RMM group reacted as though massed conditions
were not oppressive, and there were even indications that
these conditions were in some way rewarding. Furthermore,
assurance that these two groups were equal in ability is
given both by the very early learning trials and by the final

practice period scores.

Our previously-used interpretation of a flight reaction

'5

on the part of reactive schizophrenics explains this seeming

 

N‘s—f, .
’.
«.n'n—hn_

paradox. If it is assumed that both groups (RDD and RMM)
are impelled toward escape from a distressing life situation,
the rest follows logically. It could be predicted that
massed conditions, being more demanding, would therefore
provide a more nearly complete escape. The massed practice
group would then obtain secondary gains from the "noxious"
conditions. On the other hand, distributed practice could
be expected to offer relief during early learning, but then
to provide a less and less satisfactory avenue of escape as
skill progressed. Subjects would then be expected to reach
satiation more quickly, and performance would fall off.
This is, of course, exactly what was found in the two groups'
performance.

The reactive patients' tendency to quickly become
satiated or bored when an activity no longer furnishes
diversion, hypothesized above, may also be a partial ex-

planation for observation that schizophrenics seem unable to

80

maintain set during a prolonged task (51, 57, 58, 59, 60, 76,
87, 104, 106).

At this point, it may be noted that a generalized reac-

tion pattern of attempted escape from an oppressive situation

could also be used to explain the faster warm-up of reactive

patients. They, being in a "high drive", "ready for action"

state would be exPected to enter more quickly into any act-

ivity that offered itself.

This interpretation of the data is consistent with the

learning theory principle that, given sufficient drive to

elicit an activity, differences in drive or motivation affect

amplitude of response but do not affect learning. It will
be recalled that the various manipulations of spacing and

massing of practice had significant effects upon the per—

formance of the subjects. Nevertheless, all groups achieved

at the same level during the final three minutes under identi-
cal conditions.

These findings are in accord with those of Reisman (98)
who concluded that "...reactive schizophrenics, unlike
process, appear to be avoiding a noxious environment".

In a theoretical article published as the present in-
vestigation was nearing completion, Mednick (89) also sug-

gested "...that acute schizophrenics are organisms in a

state of heightened drive". As Mednick also points out, a

heightened drive state on the part of "acute" patients is

consistent with the physiological findings cited at the

81

 

fir—r“ - ‘
aw .

 

 

beginning of the present report (36, 46, 47, 48, 49, 87).

Something like a converse situation seems to obtain with
respect to the process schizophrenics. They entered into
the new situation less quickly, but then improved steadily
as long as the conditions were unchanged. With a shift to
the less noxious spaced conditions of practice they, like
the reactive sample, improved in performance. Unlike the
reactives, however, process patients shifted from D to M
showed a disruption of performance and process patients con-
tinued on D conditions continued to improve in performance.
As was mentioned earlier, during the second practice period,
the PDD group slightly surpassed the RDD group in performance
whereas in the first period, the RDD group had scored higher
by a significant amount.

Three different interpretations might be given to the
behavior of the process groups. First, it might be argued
that they simply were at a homeostatic or "low drive" state.
Thus they would be responding more or less like normal sub-
jects to the stimuli present in their external environment.
In this case, no special habit patterns of responding would
be involved. Another possibility is that the process schizo-
phrenics were responding in the same way as the reactives,
but with a lag in the onset of the various reactions.. The
third possibility is that a difference in habitual modes of
adjusting exists between the two psychotic groups. These

possible interpretations will be discussed separately.

82

 

 

 

That the process patients were responding like normals
seems to be contraindicated by several factors. First, their
mean scores were considerably below those of normal subjects.
This argument will become more compelling as it develops that
all differences isolated by the present study can be adequately
explained through the actions of psychological factors.
Secondly, the small difference between scores by the PM and
PD group in the first session is not found among normal sub-
jects. In the third place, the disruptive effect on group
PDM of being shifted to massed conditions is not ordinarily
found among normal subjects.. Another factor making homeo-
stasis no more probable for the process group than for the
reactives is that both groups were controlled for duration
of psychosis. Although the process group, by definition,
"grew" into their psychosis more slowly than the reactives,
no member of either group had been overtly psychotic for
more than a year. Subjective evidence in the same direction
is provided by the investigator's impression of the process
patients as being as acutely psychotic as were the reactives.

The second possibility, that there was simply a lag in
adaptation by the process group, is not so easily disposed
of. It may be that with longer prolongation of practice,
the process groups would show the same performance character-
istics as those shown more quickly by the reactive sample.
Only a very considerable extension of practice could fur-

nish conclusive evidence for or against this possibility.

83

 

 

 

The fact remains, however, that no indication of such a
shiftvms obtained in the present investigation. Further-
more, indications in support of the remaining interpretation
did appear in the data.

That a difference in habitual modes of adjusting brought
about the observed differences in performance seems probable.
While the reactive patients seemed quite clearly to be show-
ing a response of flight from the existing situation, the
process patients' responses were more suggestive of an un-
willingness or inability to venture into a new activity.
Thus they entered a novel situation more SIOWIy and tentat-
ively. With success, they became more and more involved in
the task, and showed more of the usual reactions with respect

to the experimental variables.

This concept also explains the otherwise peculiar
response of the PDM group during the second practice session.
They had experienced success under spaced conditions and
then were shifted to a more difficult condition. Their reac-
tion then was one of being thwarted and of drawing back from
the situation. Consequently, performance was disrupted.
With further practice, they recovered and eventually achieved
the same degree of skill as the other psychotic subjects.

All four groups of process schizophrenics followed this
general pattern of initial slowness of entering. into the
task, followed by a gradual increase in commitment as they

experienced success and became more secure in the situation.

84

 

 

It may be concluded that these process patients had not

reached a comfortable homeostatic balance. Rather, their

 

hesitancy about venturing into activity gave evidence of
their being anxious and ill-at-ease with their life situa-
tions. A major difference between the groups seems to lie

in the process patients reluctance to expose themselves to

:3”— \n G -‘.’
. g .l
f

potentially threatening situations, while the reactives

showed ea erness to chance their current circumstances.
5 a

 

The present findings with respect to process schizo-

in? Tim

1. .fl.

phrenics are in agreement with the physiological findings of
DeVault (36) in his study of process and reactive patients
and Williams' (119) study of "early chronic" schizophrenics.
They are also in agreement with some other studies of motor
behavior in "chronic" schizophrenia (76, 87), and with
Reisman's findings regarding process schizophrenics (98).

In the study just cited, Reisman concluded that the
response pattern of is process group on a different kind of
task was best described as one of habitual withdrawal from
psychologically neutral stimuli. This description would
seem to fit the present process group fairly well. In the
Present case, however, the response seemed to be more one of
guardedness and readiness to withdraw rather than immediate
and non-selective withdrawal from all stimuli. This dif-
ference may well be brought about by differences in duration
of the psychosis. Reisman chose subjects whose current

hospitalizations were for less than one year. Presumably,

85

previous hospitalizations were more or less ignored. The
present study was confined to subjects whose psychoses were

less than one year in duration. It seems possible, then,

 

that Reisman's subjects simply showed a further development
of habit patterns more or less incipient in the present
sample.

Our present evidence, then, seems to be most reasonably

interpreted by ascribing different habitual modes of adjust-

ing to the two psychotic groups. The pattern followed by the

 

reactives was one of unrest in their present circumstances
and a readiness to move into new situations. This might be
described as a flight or Withdrawal from their internal
environments. The process patients, on the other hand,
demonstrated hesitancy and slowness in entering into a new
situation; a sort of tentative withdrawal from the external
environment.
Limitationg pf Conclusions

The present investigation, being confined to variables
in a single motor learning situation, generalizations con-
cerning other areas must be held tentatively. It is worth
noting, however, that these results are consistent with
findings from studies utilizing different tasks (50, 76,98),
with some conditioning studies (23, 42, 87, 94, 126) and
with physiological evidence (36, 46, 47, 48, 49, 119). The
data also provide reasons for believing that the observed

differences arose from differing habits of reacting or

86

generalized attitudes rather than from factors specific to
motor learning.

Conclusions regarding permanent or conditioned inhibition
are somewhat open to question. The accepted measure of con-
ditioned inhibition is calculation of the difference remain-
ing between spaced subjects and massed subjects in the first
post-rest trial. The assumption here is that temporary in-
hibition does not accumulate during spaced practice, there-
fore conditioned inhibition cannot be generated under these
conditions. hen, since temporary inhibition in massed sub-
jects dissipates during rest, any remaining difference will
be due to conditioned inhibition in the massed practice
group. Since a demonstrable amount of temporary inhibition
did occur in the RD group, the above assumptions were ob-
viously not met. Therefore we have no good evidence whether
or not conditioned inhibition was generated in the present
samples to differing degrees.

Nevertheless, it is worth noting that significant
amounts of conditioned inhibition were shown after the first
practice session by the reactive groups. By the end of the
five-minute rest following the second practice session
neither group showed a sivnificant amount of conditioned
inhibition. Something like this phenomenon was found by
Ammons (10) in a study of normals under prolonged practice.
After all groups were approaching their ceiling performance,

differences tended to disappear.

87

 

 

 

 

“~ ”a.

‘

'L._
H

1?,

.As was stated, this finding must be viewed with reser-
vation with respect to determining whether or not conditioned
inhibition was actually present. Despite this reservation,
some conclusions can legitimately be drawn from the finding.

The outstanding fact is that differences between the D and

M crou ps of both psycr otic categories had disappeared after F1

H
only 18 minutes of practice. Rot only were there no differ- '
ences during the first post-rest trial of period 3, but also

none for the final practice session considered as a unit.

,-

~ L) by

This might be interpreted as an indication that already

‘

estaslish ca p0 tterns of eactizg were so firmly intrenched in
these psychotic samples that they interfered with "normal"
reactions to stimuli. Normally, of course, the DD grOL wp
would be eXpected to surpass MK groups due to c:Lditf_oned
inhibitknlin the la tter.

Perhaps it wou i he more justified to conclude more
specifically that, for some reason, DD conditions were reacted
to as being as noxious e.s LM condition"

Implications

Obviccs y, replication of all or part of the present
study with predictions that the sane maior phenomena would
appear would aid in evaluat:ung the present findings. Al-
though these results are in aereement with several differing
lines of inves 3 tion, there have been relatively few

studies Mp6 rating process and reactive schizophrenics as

sudi. Fbr this reason, co We. bilit" of samples is often

I-

88

 

questionable. It is possible to find supportive evidence for

almost any proposition among the mass of often-contradictory

literature on "schizophrenia"

considered as an entity.

A considerable extension of the duration of practice
would also be of interest as a further check on the con-
sistency of the observed trends. Since, in the present
study, it was found that selection of subjects was most
arduous and time-consuming, it would seem to be in the in-
terests of efficiency to make every possible use of subjects

once they are identified.

The present findines could account for the better prog-

nosis for reactive patients without recourse to physiological

differences. The fact that reactives respond more quickly
to environmental differences would make them more amenable
to therapeutic manipulations. This could be expected to be
a spiraling thing, so that even small differences in rate of

responding would bring about an ever-increasing gap between

the two groups analagous to "fast learners" and "slow learners"

in ordinary school situations.

In addition to rate of responding, the reactives' ap-
parently greater drive level and their greater ability to
enter into a new situation could be eXpected to lead them to
try more varied adjusting techniques. Thus, their prognosis
for either spontaneous remission or for therapy would be
better if it is assumed that movements towards mental health

will be rewarding to them and thus more apt to be retained

89

{56“ ----— fl_‘ ‘mafla—I-n- .“W
a; I '

:9

h

~J-H... .-.

‘.

 

or repeated. Even without such an assumption, it could be
predicted that the reactive schizophrenics' trial beiavior
would most probably lead to some kind of change, and the
change would be for the better at least part of the time.

Another implication concerning the reactives is that
they seem disturbed by something in their own life situations.
This at least presents the possibility that identification
and amelioration of the disturbing circumstances may relieve
their conditions.

Another implication is that, since reactives seem to be
fleeing a noxious life situation, early discharges and passes
to return to the conditions associated with onset of psycho-
sis should be avoided. Although, as a group, they recover
quite quickly when hospitalized, more time would be needed
to change habit patterns and attitudes. Longer hospital-
izations for these patients might cut down the "return rate",
or re-admissions, considerably.

In short, the present results point to the hardly-
surprising conclusion that reactive schizophrenics should be
more amenable to conventional psychotherapeutic approaches,
to environmental manipulations, and to spontaneous remissions.
It might be added that tranquilizinc drugs could also be ex-
pected to be more efficacious for the reactives by calming
and controlling their flight reactions, and enabling them
to continue longer at a task.

ilmplications with respect to the process group are not

90

 

so optimistic, but they are by no means totally negative.

First, since process schizophrenics seem to be hesitant
to initiate new activities, hey could not be expected to
show "spontaneous remission" as frequently as the reactives.
This is a conclusion made after the fact, incidentally, since
this is a well-established finding from other studies (19,
20, 123, 124). However, it does follow from the present data.

Of more interest is the implication that process
schizophrenics would not be apt to be helped, but perhaps
made worse by conventional psychotherapy. This folloWS
from the fact that these patients are withdrawing from the
external environment. Psychotherapy focused upon the patient's
feelings and inner life would most probably tend to ac-
centuate this non-adaptive behavior.

From the present findings, it would seem that the ther-
apy of choice for process patients, whatever the duration of
their psychosis, should be in the other direction. That is,
envouragement to attend to and to manipulate the environment
to an ever-increasing degree. Since they are prone to with-
draw from frustration or threat, extreme caution would need
to be exercised during the early stages. manipulative tasks
should be of a nature to provide many opportunities for
success but a minimum amount of threat.

Interestingly enough, a few recent papers (74, 94, 115)
report some success in Just such a "reconditioning" program

for "chronic schizophrenics".

91

 

‘Whether or not "shock therapy" could be eXpected to make
tkuejprocess patients sufficiently uncomfortable in their
sitaurtion to drive them from self preoccupation is a debat-
able question. There is some face validity to the proposition.
Cki the other hand, it could be held with equal lOgio that,
since shock is imposed from without, it would lead to an even
more profound distrust and rejection of the environment.
.Actuarial evidence is somewhat on the side of negative re-

sults for "chronic" patients. Since process patients have

'Uae poorer prognosis, it seems reasonable that a larger pro-

portion of patients labeled "chronic" would also be class-

ified as "process".

An interesting incidental conclusion can be drawn from

the performance of the normal group under conditions that

were relatively easy for them. The shape of their perfor-

mance curve seems to furnish corroborative evidence for one
of Hull's (56) postulates that has not been widely tested.
Hull postulated that increments in habit strength can be con-
sidered as a constant fraction of gain yet to be attained.

As the limit to which the skill which can be attained (ceil-
ing) is approached, the increments in habit, according to
Hull, become progressively smaller. Then,

since temporary

inhibition generated in a task seems to build up to a maximum

and then to remain fairly constant, it would be approximately

the same regardless of the stage of learning. Thus it

follows that the relative decrement from temporary inhibition

92

 

5
L'
L
1
' r"
W
F‘-

 

 

auld be greater the closer performance is to the ceiling.
ince the normal 50 rpm group is considerably closer to the
ailing at the end of the first practice period than normals

t 60 rpm, it is understandable why the present normal-

lSSed learning curve flattens and dips at the end of the

irst practice period although this is not the case at 60 rpm.
3 other words, this dip would support Hull's notion that

shit is negatively accelerated.

93

 

 

 

SUMMER!

The present study was concerned with performance of
process and reactive schizophrenics on a rotary pursuit task.

A process schizophrenic is best described as having an
early and insidious onset of psychosis with a relative ab-
sence of precipitating stress. Typically, he has had an in-
adequate prepsychotic personality. He shows a tendency to
avoid interpersonal contacts and presents a clinical picture
of flat affect and a relat ve absence of confusion.

A reactive schizophrenic, on the other hand, is one With
a relatively abrupt and stormy onset of psychosis, usually
attributable to a logical and significant stress situation.
The prepsychotic personality has been normal or neurotic,
rather than schizoid, with perhaps some degree of outgoing—
ness. The clinical picture following the psychotic break is
likely to include severe confusion and many affective com-
ponents.

In the present investigation, Becker's modification of
the Elgin Prognostic Scale was chosen as the device for
selection of process and reactive subjects from the schizo-
phrenic population of a neuropsychiatric hospital. All
patients who met the criteria for the sample desired were
rated on this scale. Their ratings were found to approximate
a normal distribution. Subjects in the lower and upper tails

L~-J

of the distribution were classified as reactive nod process

94

 

 

 

respectively.

The subjects so selected were tested on a pursuit rotor
in order to obtain measurements of their adaptive behavior
in a motor learning situation. Groups from each psychotic

category were assigned to identical conditions of spacing

 

and massing of practice while learning the task. Comparisons a?

of the adaptive responses of process and reactive schizo- :‘

1
phrenics were then made. r
I

 

Differences which showed a high degree of consistency F
throughout the testing were obtained. Statistical treatment 4"
of the data provided considerable assurance that these dif-
ferences were not chance occurrences.

The chief findings with respect to process schizophrenics
were: They took longer to adapt themselves and enter into
the task. After a rest, they also took longer to regain

their set and warm up in resuming practice. When the e

u.

d)

patients were continued under the same conditions for suc-
cessive practice periods, they progressively improved in per-
formance. When Shifted from spaced practice conditions to
the relatively more demanding massed conditions, however,
their performance was markedly disrupted.

These results were interpreted as indications that
process schizophrenics were hesitant in initiating new act-
ivities and prone to withdraw when thwarted. Supportive
evidence for this interpretation was cited from studies of

"chronic" schizophrenia and from the few reported studies

95

that have made use of the process-reactive concept.

Findings regarding reactive schizophrenia were largely
in the opposite direction. They entered into the novel
situation more quickly and took a shorter time to regain set

after a rest. When continued under the relatively undemand-

 

ing spaced conditions of practice, their performance deter-
iorated. On the other hand, performance continued to im-

prove with successive periods of massed practice. When con-

m .‘i‘m: III-"a i,
I

ditions of spacing and massing were shifted in either dir-

 

21'.“

1‘;

ection, the reactive patients showed an immediate improvement
in performance suggestive of an elation effect.

These results were interpreted as evidence that reactive
schizophrenics avoided their internal environments by a flight
into activity. Then, when increasing skill rendered the task

less effective as an escape device, satiation set in quickly.

 

Any change in the task was therefore reacted to positively.

Supportive evidence for this interpretation was also
cited from the literature.

Finally, some of the implications of these findings with
respect to therapy and prognosis were pointed out.

As an incidental finding, supportive evidence was ob-
tained for Hull's postulate that increments in habit strength
may be considered as a constant fraction of the amount yet

to be attained.

96

‘0
O

10.

ll.

l2.

13.

BI BLI OGRAPHY

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4"” i "..'

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:' I' rm-

“g -

 

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97

 

 

14.

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BIBLIOGRAPHY (cont.)

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98

 

 

 

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100

 

 

W?"‘
:..
~

 

 

 

BIBLIOGRAPHY (cont.)

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101

73.

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BIBLIOGRAPHY (cont.)

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a. ‘1 ‘n -

 

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53'7“"

 

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104

 

 

 

114.

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1 941 , fl, 271-3230

105

 

 

 

 

 

UPMIX

 

 

106

Scale of Apparent Psychosis

 

 

 

 

 

 

 

Subject Ward
Date Rater

;: I I “11L 4
No readily Evidence of psychotic EVidence of lit-
discernible thinking and behavior, tle else but
evidence of and of non-psychotic psychotic think-
psychotic thinking and behavior ing and behav-
thinking or about equally divided ior; no readi-
behcvior; 1y discernible

non-psychotic
thinking and
behavior read-
ily discern-
ible

evidence of non-
psychotic think-
ing and behav-
ior.

107

Becker's Revision-Elgin Prognostic Scale

The definitions for the subscales of the Elgin Prognostic
Scale and modified by the writer for use in this study are
given below. Items A through 0 are rated on the basis of
anamesis data. Items P through T are rated on the basis of

the presenting clinical symptoms.

A. Defects of interest versus definite display of interest.

0. Keen ambitious interest in some of the following: home,
family, friends, work, sports, arts, pets, gardening, social

activities, music, dramatics.

2. Moderate degree in several activities including social
gatherings, sports, music, opposite sex, etc.

4. Mild interest in a few things such as Job, family,
quiet social gatherings. The interest is barely sustaining.

6. Hithdram and indifferent toward life interests of
average individual. No deep interests of any sort.

B. Insidious versus acute onset.

0. Development over a period of 0-1 months with sudden,
dramatic divorcement from more or less commonplace living.

1. Development over a period of 2-4 months with marked
personality changes from relatively commonplace living.

2. Development over a period of 5-7 months with moderate
personality changes. may be some accenting of previous

trends, but changes also.

3. Changes have taken place over a period of 8—12 months
with noticeable personality modifications, but primarily an
accenting of existing trends.

4. Slow development of symptoms but possible to detect
personality changes in the 2 years prior to onset.

6. Very slow development of symptoms so that the final
disorder appears as an exaggeration of already strongly
accentuated personality traits. Indications even prior to

adolescence.

C . Shut-in-personality .

General: The psychotic condition is simply an exagger—
ation of the peculiar type of personality shown all through
childhood. Stormy childhood often with over-protection and

a difficult adolescence characterized by inability

anxiety,
to get along and mix with other children. Constitutional

108

 

 

 

apparently, rather than product of specific environment.
5. Very much as described above.
3. Mbderately the picture described above.
1. Only mildly this way, but some resemblance to pattern.
0. Apparently normal childhood, little evidence of shy—

ness, unusual difficulty or else unusual behavior is
attributable to environmental factors.

 

D. Schizothymic versus syntonic personality.

0. Very sociable, fond of people and social gatherings;
many friends, active in groups and sports, participates in
life of his community.

2. Mbderately sociable, likes people and social gather-
ings, but doesn't go far out of way to meet people.

 

3. Mildly shy, mildly sociable. Will interact when the
situation presents itself. Prefers association in family
group as a rule.

4. Hbderately shy, retiring, etc. More concerned with
ideas than people.

6. Very seclusive, shy, retiring, mixes little with others.
Few if any close friends. Interested in ideas rather than
people. Passive onlooker at life rather than an active
participant. Poor "bite on life“.

E. Range of interests.

0. Wide and varied interest, keen bite on life and its
opportunities, forward and interested in making adaptation
to daily life in many spheres.

2..M0derate breadth of interest, interested in making
adaptations to daily life, but does not go out of way to seek
new opportunities.

4. Mbderate restriction of interests. Narrow goals, but
some detectable variety of interests within a narrow
orientation.

6. Inadequate interest in varied problems of life, rigid,
narrow goals or interests, circumscribed activities because
of the narrqw range of interests.

F. Constitutional bias.

0..A healthy, strong energetic physical and mental makeup
109

that makes the interplay between heredity and environmental
influence during childhood a satisfactory one.

2. Suggestions of defects in physical and mental stamina
occasionally observed. Not at all marked. Perhaps proneness

to repeated illnesses in childhood.

4. Regarded from early childhood as different, queer or
odd; perhaps associated with some real defect or handicap-
physical such as deformity, or speech defect, but more often
only an imaginary defect of personality.

G. Low energy tone.

0. Very strong drive, keen active and alert interest and
ambition shown in school, social and work spheres. Good
grasp on life, liked life and had energy enough to enjoy it.
Outgoing and adequate in meeting life.

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2. Moderately adequate drive, interest, energy as des-
cribed above. a

4. Mbderately inadequate energy tone. Tends toward sub-
missive, passive reactions. Shows some potential to face
life's problems, but would rather avoid them than expend the

necessary energy.

6. Submissive, inadequate passive reactions, weak grasp
on life, does not go out to meet life's problems, does not
participate actively but passively, accepts his lot without
having the energy to help himself.

H. Asthenic build.

0. Large, barrel-shaped trunk, with relatively short legs
and arms; shield shaped face, short broad head upon a thick

neck, set well down between shoulders.

2. Athletic build. Balanced weight, good musculature,
head shape, etc.; intermediate to O and 4.

4. Long, slender extremities with relatively small,
narrow trunk. Egg-shaped face ; elongated narrow head on a
tall, slender neck.

I. Heterosexual contact.

0. Purposefully contacts the other sex, dates frequently,
makes successful effort to be attractive in manner, dress,
accessories, etc. so as to be popular with girls (boys).

2. Dates when situation affords. Maybe marries, but has
difficulties in compatibility. Wants to interact with other
sex, has some techniques, but not completely successful.

110

3. If married, apt to divorce or separate. Generally this
is rated as a midpoint between 2 and 4.

4. Moderate lack of heterosexual contact. Tends to avoid
dates, dances, but has on occasion participated in same.
lflght think he (she) would like to marry some day, but little
enthusiasm for it.

6. No association with the opposite sex. Never had any
dates. Avoids dances and social gatherings which require
the intermingling of boys and girls.

J. marked academic interests versus active interest in sports.

0. An active interest in sports, participates in baseball,
basketball, tennis, football, or other sports. A solitary
sport such as swimming or golf is not so important unless
the patient plays or sw1ms with others rather than self.

1. Moderate interests in sports, and other interests.
2. Mild interest in sports, mild interest in study.
‘3. Moderate interest in study-~without other interests.

4. Fond of study, worked diligently at school and excels
in this field associated with inadequacy in sports and social
field, a grind without the ambition or drive in work and play
to equal his achievements as a student.

K. Careless indifference versus worrying, self-conscious type.

0. Subjectively sensitive, critical of self, preoccupied
with own conflicts, but shows little of the extreme, bizarre,
unusual, mysterious or socially unacceptable behavior.

2. Some concern and preoccupation with difficulties- a
moderate position to O or 4.

4. Withdrawal and disinterest in social surroundings,
careless of social requirements, given to day-dreaming and
excentricity, dirty, disheveled appearance, profane language,
unacceptable habits.

L. Exclusive stubborn traits versus insecurity and inferior-
ity feelings.

O. Timid, lacks self confidence, feels insecure and in-
ferior. Very sensitive and critical of self; feels certain
problems in life but participates and does not accept his
lot passively or without regret and struggle.

l. Mbderately like 0.
111

 

 

 

2. Neither timid nor stubborn.

3. Moderately stubborn.

4. Complete withdrawal from surroundings and interest,
inadequate in meeting life but stubborn and opinionated,
refuses to change, even if suggested, to achieve a more
adequate adjustment. Opinionated and egocentric.

M. Toxicity or eXhaustion.

0. History of illness, disease or eXhaustion closely
associated with the onset of psychotic symptoms.

1. Illness present, not severe, but related to onset.
Less severe eXhaustiqn.

2. Poor health--but not requiring bed.

 

3. Fair health--a little run down.

4. Excellent health history. Health in no sense an
etiologic factor in the development of psychosis.

N. Precipitating conditions. (Situational reaction)

0. A strong relationship between onset of symptoms and
situational problems that would require definite and continued
effort to adjust satisfactorily; i.e. death, failure, loss,
interpersonal strife. The average person would definitely
try to flee such a situation rather than attempt to change it.

1. marked stresses related to onset, but not as severe
as O.

2. Moderate stresses related to onset such as financial
jproblems, interpersonal discord, etc. which would cause
considerable worry to the average individual.

3. Mild stresses that the average person would react to
in.some way but would not usually lead to a breakdown.

4. Onset of psychotic symptoms not related to any dis-
‘turbance or difficulty in the patients situation- or a dis-
turbance of such a trivial nature that it would be ignored
or’quickly forgotten by the average person.

0. ration of psychosis.

0. Under 2 months
1. 2-4 months
2. 4-6 months
3. 6-8 months

112

S. 1-2 years
6. 2-3 years
7. Over 3 years

The following scales are rated from the presenting clinical

picture.

P. 'Inadequate affect versus emotional instability of
appropriate affect.

 

O. Adequate or overly demonstrative affective expression.
This includes appropriate expression and manic depressive
aspects in which there is a facile display of emotion.

2. Moderately inadequate affect. Tends to be rigid, dull,
or slightly inappropriate. Only moderate responsiveness to
emotional stimulation.

4. Markedly inadequate, inappropriate, rigid or dull
affect. Emotional life expressed is at odds with behavior or
strikingly inappropriate. Little reaction to stimulation of
any strength.

 

Q. Hebephrenic symptoms; extreme indifference, complete
divorce between ideas and affect; extreme carelessness in
appearance and reaction with untidiness in some cases, silly
behavior, often silly laughter without appropriate stimulation.

 

0. Not as above.

1. Mildly as above.

2. Moderately as above.

3. Markedly as above.

4. Very markedly as above.

Rt Ideas of influence; patient feels that someone or some-
thing is directing his actions, thoughts, or speech. Some
outside influence forces him to do things even against his
own will.

0. Not as above.

1. Mildly as above.

2. Moderately as above.

3. Markedly as above.

4. Very markedly as above.

8. Physical interpretation delusions. The patient has cer-
‘tain feelings (possibly hallucinations) that are linked up
*with definite delusional ideas; for instance, that there is
as snake in his stomach, that food passes right through his
‘body, that someone is passing electrical currents through his
body, that the food he eats is poisoned, etc.

0. Not as above.
1. Mildly as above.

113

2. Moderately as above.
3. Markedly as above.
4. Very markedly as above.

T. .Atypical symptoms. Manic or depressive feature mixed with
the schizophrenic picture. Display of appropriate affect,
over-talkative, distractive, facetious, display of interest

in other patients, desire to help humanity in general,
depression, feelings of sin or guilt, psychomotor retardation,
anxiety, crying.

0. Very markedly atypical picture, shows many of the above
features with considerable strength of affect.

l. Markedly atypical picture.

2. Mederately atypical picture, less intensity of features
shown.

3. Mildly atypical picture, unusual features are minimal
or lacking in intensity.

4. Lacking atypical features.

114